Robotically-controlled cable-based surgical end effectors

ABSTRACT

A cable-driven surgical tool configured to receive various control motions from a robotic system.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation patent application and claimsthe benefit of U.S. patent application Ser. No. 13/118,278, filed May27, 2011, entitled “Robotically-Controlled Surgical Stapling DevicesThat Produce Formed Staples Having Different Lengths”, which is acontinuation-in-part patent application of and claims the benefit ofU.S. patent application Ser. No. 11/711,979, filed Feb. 28, 2007,entitled “Surgical Stapling devices That Produce Formed Staples HavingDifferent Lengths” to Joseph C. Hueil, Jeffrey S. Swayze, and FrederickE. Shelton, IV, U.S. Patent Application Publication No. US 2007/0194081A1, which is a continuation-in-part patent application under 35 U.S.C.§120 of and claims the benefit of U.S. patent application Ser. No.11/216,562, filed Aug. 31, 2005, entitled “Staple Cartridges For FormingStaples Having Differing Formed Staple Heights,” by F. Shelton, now U.S.Pat. No. 7,669,746, issued Mar. 2, 2010, the respective disclosures ofwhich are all herein incorporated by reference in their respectiveentireties.

The present application is also related to the following,concurrently-filed U.S. patent applications, which are incorporatedherein by reference:

-   (1) “Surgical Stapling Device With Staple Driver That Supports    Multiple Wire Diameter Staples,” by J. Swayze et al., U.S. patent    application Ser. No. 11/711,977, now U.S. Pat. No. 7,673,781;-   (2) “Surgical Stapling Device With Anvil Having Staple Forming    Pockets Of Varying Depth,” by J. Morgan et al., U.S. patent    application Ser. No. 11/714,049, now U.S. Patent Publication No.    2007/0194082;-   (3) “Surgical Stapling Device With Multiple Stacked Actuator Wedge    Cams For Driving Staple Drivers,” by J. Hueil et al., U.S. patent    application Ser. No. 11/712,315, now U.S. Pat. No. 7,500,979;-   (4) “Surgical Stapling Device With Staple Drivers Of Different    Height,” by J. Hueil et al., U.S. patent application Ser. No.    11/711,975, now U.S. Patent Publication No. 2007/0194079; and-   (5) “Staple Cartridges For Forming Staples Having Differing Formed    Staple Heights,” by F. Shelton, IV, U.S. patent application Ser. No.    12/695,359, now U.S. Patent Publication No. 2010/0127042.

FIELD OF THE INVENTION

The present invention relates in general to stapling instruments thatare capable of applying lines of staples and, more particularly, toimprovements relating to staple cartridges for use with surgicalstapling instruments that are capable of applying lines of stapleshaving differing formed staple heights to tissue while simultaneouslycutting the tissue.

BACKGROUND OF THE INVENTION

Surgical staplers have been used in the prior art to simultaneously makea longitudinal incision in tissue and apply lines of staples on opposingsides of the incision. Such instruments commonly include a pair ofcooperating jaw members that, if the instrument is intended forendoscopic or laparoscopic applications, are capable of passing througha cannula passageway. One of the jaw members receives a staple cartridgehaving at least two laterally spaced rows of staples. The other jawmember defines an anvil having staple-forming pockets aligned with therows of staples in the cartridge. The instrument includes a plurality ofreciprocating wedges that, when driven distally, pass through openingsin the staple cartridge and engage drivers supporting the staples toeffect the firing of the staples toward the anvil.

An example of a surgical stapler suitable for endoscopic applications isdescribed in U.S. Patent Application No. US 2004/0232196 A1, thedisclosure of which is herein incorporated by reference in its entirety.In use, a clinician is able to close the jaw members of the stapler upontissue to position the tissue prior to firing. Once the clinician hasdetermined that the jaw members are properly gripping tissue, theclinician can then fire the surgical stapler, thereby severing andstapling the tissue. The simultaneous severing and stapling avoidscomplications that may arise when performing such actions sequentiallywith different surgical tools that respectively only sever or staple.

Whenever a transsection of tissue is across an area of varied tissuecomposition, it would be advantageous for the staples that are closestto the cut line to have one formed height that is less than the formedheight of those staples that are farthest from the cut line. Inpractice, the rows of inside staples serve to provide a hemostaticbarrier, while the outside rows of staples with larger formed heightsprovide a cinching effect where the tissue transitions from the tightlycompressed hemostatic section to the non-compressed adjacent section. Inother applications, it may be useful for the staples in a single line ofstaples to have differing formed heights. U.S. Pat. Nos. 4,941,623 and5,027,834 to Pruitt disclose surgical stapler and cartridge arrangementsthat employ staples that have different prong lengths to ultimatelyachieve lines of staples that have differing formed heights. Likewise,WO 2003/094747A1 discloses a surgical stapler and cartridge that has sixrows of staples wherein the outer two rows of staples comprise staplesthat are larger than the staples employed in the inner two rows andmiddle rows of staples. Thus, all of these approaches require the use ofdifferent sizes of staples in the same cartridge.

BRIEF SUMMARY OF THE INVENTION

In one general aspect, the present invention is directed to surgicalstapling devices that are capable of producing staples of differentformed lengths. For example, in such a device that also cuts the tissuebeing stapled, the inside rows of staples closest to the longitudinalincision line could have a formed height that is less than the formedheight of the outer rows of staples. That way, the inside rows ofstaples may provide a hemostatic barrier, while the outside rows ofstaples with larger formed heights may provide a cinching effect wherethe tissue transitions from the tightly compressed hemostatic section tothe non-compressed adjacent section.

According to various implementations, the staple cartridge may havestaple drivers of different heights to product staples having differentformed lengths. The staples driven by the shorter staple drivers wouldhave longer formed lengths (assuming no other differences that wouldaffect the formed heights of the staples). Also, the staple formingpockets in the anvil may have different depths. Staples formed in deeperpockets would tend to be longer than staples formed in shallow pockets.In addition, some of the staple forming pockets may be formed incompliant material portions of the anvil. Staples formed in such pocketswould tend to be longer than staples formed in a non-compliant (or lesscompliant) portion of the anvil. Additionally, the channel may haveinternal steps that would produce staples having different formedheights. Staples formed with staple drivers starting at a lower stepwould have a longer formed length that stapled formed with stapledrivers starting at a higher step. Also, staples with different wirediameters may be used. Thicker staples would tend to produce stapleswith longer formed lengths. In that connection, embodiments of thepresent invention are directed to staple pushers that can accommodatestaples of varying wire thicknesses. Also, staples of differingmaterials could be used. Staples made of stronger, less compliantmaterials, would tend to produce longer formed staples.

According to other embodiments, the surgical stapling device maycomprise a plurality of stacked wedge band sets. Each stacked wedge bandset may comprise a number of wedge bands stacked one on another. Thewedge bands may be actuated in succession in order to drive the staplesin successive stages. That is, for example, in an embodiment havingthree wedge bands in a stack, the first wedge band may be actuated firstto partially deploy the staples, the second wedge band in stack may beactuated next to begin to form the staples, and the third wedge band inthe stack may be actuated last to finish the formation of the staples.To produce staples having different formed heights, the heights of thestacks (corresponding to the cumulative height of the wedge bands in thestacks) may be different, for example.

The techniques used to create formed staples of different heights couldbe used in a variety of different surgical stapling devices. Forexample, the stapling devices could be devices that cut the clampedtissue or devices that include no cutting instrument. The surgicalstaplers may be, for example, endocutters, open linear stapler devices,or circular staplers.

In accordance with other general aspects of various embodiments of thepresent invention, there is provided a staple cartridge for use with astapling device that has a robotically controlled actuator that isselectively actuatable in an axial direction and an anvil portion thatis selectively movable between open and closed positions. In variousembodiments, the staple cartridge comprises a cartridge body that issupportable within the stapling device for selective confrontingrelationship with the anvil portion thereof when in a closed position.The cartridge body is configured to axially receive a dynamic actuationmember therein that is responsive to control motions applied thereto bythe robotically controlled actuator. At least one first staple driver ismovably supported within the cartridge body for contact by the dynamicactuation member such that, as the dynamic actuation member is axiallyadvanced through the cartridge body when a first control motion isapplied thereto by the robotically controlled actuator, the first stapledrivers are driven in a direction toward the anvil when the anvil is inthe closed position. Each first staple driver defines a first staplesupport cradle for supporting a staple thereon. The first staple supportcradle is located a first staple forming distance from a correspondingportion of the closed anvil. At least one second staple driver ismovably supported within the cartridge body for contact by the dynamicactuation member such that as the dynamic actuation member is axiallyadvanced through the cartridge body, the second staple drivers aredriven in the direction toward the closed anvil. Each of the secondstaple drivers define a second staple support cradle for supportinganother staple thereon. The second staple support cradle is located asecond staple forming distance from another portion of the closed anvilwherein the second staple forming distance differs from the first stapleforming distance.

In accordance with other general aspects of various embodiments of thepresent invention, there is provided a surgical stapling device thatincludes a robotic system that is operable to produce a firing motionand a closing motion. The device further includes an implement portionthat is responsive to the firing and closing motions from the roboticsystem. In various forms, the implement portion includes an elongatechannel that is operably coupled to a portion of the robotic system andis configured to support a staple cartridge therein. An anvil is movablycoupled to the elongate channel and has an anvil channel therein. Theanvil is movable from an open position to a closed position uponapplication of the closing motion thereto from the robotic system.Various embodiments further include a firing device that includes adistally presented cutting edge that is longitudinally movable withinthe elongate channel and the anvil from a starting position to an endingposition upon application of the firing motion thereto from the roboticsystem. The firing device has an upper portion for engaging the anvilchannel and a lower portion for engaging the elongate channel duringdistal movement for firing. Various forms of the staple cartridgecomprise a cartridge body that is sized to be supported within theelongate channel. The cartridge body has a longitudinally extending slottherein for receiving the firing device therein. The cartridge body hasa non-planar deck surface that is configured to confront a stapleforming portion of the anvil that has staple forming pockets thereinwhen the anvil is in the closed position. A first plurality of insidestaple drivers is axially aligned in a first row of inside stapledrivers in a portion of the cartridge body that is adjacent a first sideof the longitudinally extending slot. A second plurality of insidestaple drivers is axially aligned in a second row of inside stapledrivers in another portion of the cartridge body that is adjacent asecond side of the longitudinally extending slot. The inside stapledrivers are movably supported within the cartridge body for selectivemovement toward the anvil when the anvil is in a closed position. Eachinside staple driver defines a first staple support cradle forsupporting a staple thereon. Each first staple support cradle is locateda first staple forming distance from a corresponding portion of theanvil when the anvil is in a closed position. A first plurality ofoutside staple drivers is axially aligned in a first row of outsidestaple drivers that are adjacent to the first row of the inside stapledrivers. A second plurality of outside staple drivers is axially alignedin a second row of outside staple drivers and is adjacent to the secondrow of inside staple drivers. Each of the outside staple drivers ismovably supported within the cartridge body for selective drivingmovement toward the anvil when the anvil is in the closed position. Eachof the outside staple drivers define a second staple support cradle forsupporting another staple thereon. Each second staple support cradle islocated a second staple forming distance from another correspondingportion of the anvil when the anvil is in the closed position. Thesecond staple forming distance differs in magnitude from the firststaple forming distance. A wedge sled is supported within the cartridgebody for driving contact by the firing device and actuating contact withthe first and second pluralities of the inside staple drivers as well asthe first and second pluralities of outside staple drivers such that, asthe firing device moves within the elongated slot in the cartridge bodyin a first axial direction in response to the firing motion from therobotic system, the wedge sled drives each of the inside and outsidedrivers towards the anvil to bring the staples supported thereon intoforming contact with the anvil when the anvil is in the closed position.

BRIEF DESCRIPTION OF THE FIGURES

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate by way of example embodiments ofthe invention, and, together with the general description of theinvention given above, and the detailed description of the embodimentsgiven below, serve to explain the principles of the present invention,wherein:

FIG. 1 depicts a partially cut away side elevation view of a surgicalstapling and severing instrument in an open position according tovarious embodiments of the present invention;

FIG. 2 depicts a cross-sectional side elevation detail view along theline 2-2 of FIG. 1 of an end effector of the surgical stapling andsevering instrument according to various embodiments of the presentinvention;

FIG. 3 depicts an enlarged side elevation view of the firing bar of thesurgical stapling and severing instrument of FIG. 2 according to variousembodiments of the present invention;

FIG. 4 depicts an enlarged front view of the firing bar of the surgicalstapling and severing instrument of FIG. 2 according to variousembodiments of the present invention;

FIG. 5 depicts a cross-sectional side elevation detail view of analternative end effector for the surgical stapling and severinginstrument of FIG. 1, incorporating a firing bar that lacks a middle pinfor preventing pinching of the end effector, according to variousembodiments of the present invention;

FIG. 6 depicts a side elevational view of a handle portion of a proximalend of the surgical stapling and severing instrument of FIG. 1 with aleft side removed to expose interior parts in an unclamped, unfired(“start”) position according to various embodiments of the presentinvention;

FIG. 7 depicts a perspective, exploded view of the handle portion of theproximal end of the surgical stapling and severing instrument of FIG. 1according to various embodiments of the present invention;

FIG. 8 depicts a side elevational view of the handle portion of theproximal end of the surgical stapling and severing instrument of FIG. 1with the left side removed to expose interior parts in the closed(“clamped”) position according to various embodiments of the presentinvention;

FIG. 9 depicts a side elevational view of the handle portion of proximalend of surgical stapling and severing instrument of FIG. 1 with the leftside removed to expose interior parts in the stapled and severed(“fired”) position according to various embodiments of the presentinvention;

FIG. 10 depicts a plan view of a staple cartridge installed in an endeffector according to various embodiments of the present invention;

FIG. 11 is an enlarged plan view of a portion of a staple cartridgeaccording to various embodiments of the present invention;

FIG. 12 is a side view of a staple that may be employed with variousembodiments of the present invention;

FIG. 13 is a front elevational view of one inside double driversupporting two staples thereon according to various embodiments of thepresent invention;

FIG. 14 is a top view of the inside double driver and staples of FIG. 13according to various embodiments of the present invention;

FIG. 14A is an elevational view of the inside double driver of FIG. 13within a portion of a staple cartridge mounted in the end effector andalso illustrating a corresponding portion of the anvil when in a closedposition according to various embodiments of the present invention;

FIG. 15 is a right side elevational view of the inside double driver andstaples of FIGS. 13 and 14 according to various embodiments of thepresent invention;

FIG. 15A is another side elevational view of the inside double driver ofFIG. 15 wherein corresponding portions of the cartridge tray and anvilare illustrated in broken lines to depict the relationships therebetweenaccording to various embodiments of the present invention;

FIG. 16 is a front elevational view of one outside single driversupporting a staple thereon according to various embodiments of thepresent invention;

FIG. 16A is another front view of the outside single driver of FIG. 16with portions of the cartridge tray and anvil shown to illustrate therelationships therebetween according to various embodiments of thepresent invention;

FIG. 17 is a top view of the outside single driver and staple of FIG. 16according to various embodiments of the present invention;

FIG. 18 is an isometric exploded view of the implement portion of thesurgical stapling and severing instrument of FIG. 1 according to variousembodiments of the present invention;

FIG. 19 is a section view taken along line 19-19 of FIG. 10 showing thecross-sectional relationship between the firing bar, elongate channel,wedge sled, staple drivers, staples and staple cartridge according tovarious embodiments of the present invention;

FIG. 19A is another cross-sectional view of an end effector showing thecross-sectional relationship between the firing bar, elongate channel,wedge sled, staple drivers, staples, staple cartridge and anvilaccording to various embodiments of the present invention;

FIG. 20 is a perspective view of one wedge sled according to variousembodiments of the present invention;

FIG. 21 is a side elevational view of an inside sled cam of the wedgesled depicted in FIG. 20 according to various embodiments of the presentinvention;

FIG. 22 is a side elevational view of an outside sled cam of the wedgesled depicted in FIG. 20 according to various embodiments of the presentinvention;

FIG. 23 is an isometric view of the end effector at the distal end ofthe surgical stapling and severing instrument of FIG. 1 with the anvilin the up or open position with the cartridge largely removed exposing asingle staple driver and a double staple driver as exemplary and thewedge sled in its start position against a middle pin of the firing baraccording to various embodiments of the present invention;

FIG. 24 is an isometric view of the end effector at the distal end ofthe surgical stapling and severing instrument of FIG. 1 with the anvilin the up or open position exposing the staple cartridge and cuttingedge of the firing bar according to various embodiments of the presentinvention;

FIG. 25 is an isometric view of the distal end of the surgical staplingand severing instrument of FIG. 1 with the anvil in the up or openposition with the staple cartridge completely removed and a portion ofan elongate channel removed to expose a lowermost pin of the firing baraccording to various embodiments of the present invention;

FIG. 26 is a side elevation view in section showing a mechanicalrelationship between the anvil, elongate channel, and staple cartridgein the closed position of the surgical stapling and severing instrumentof FIG. 1, the section generally taken along lines 26-26 of FIG. 24 toexpose wedge sled, staple drivers and staples but also depicting thefiring bar along the longitudinal centerline according to variousembodiments of the present invention;

FIG. 27 is a cross-sectional view of a portion of a staple cartridgewherein an outside cam of a wedge is adjacent to an outside singledriver according to various embodiments of the present invention;

FIG. 28 is a cross-sectional view of a portion of a staple cartridgewherein an outside cam of a wedge sled is engaging three outside singledrivers according to various embodiments of the present invention;

FIG. 29 is a diagrammatic representation of lines of staples installedon each side of a cut line using a surgical stapling and severinginstrument according to various embodiments of the present invention;

FIG. 30 depicts a staple formed by one inside driver according tovarious embodiments of the present invention;

FIG. 31 depicts another staple formed by one outside driver according tovarious embodiments of the present invention;

FIG. 32 is a diagrammatic representation of lines of staples installedon each side of a cut line using a surgical stapling and severinginstrument according to various embodiments of the present invention;

FIG. 33 is a diagrammatic representation of lines of staples installedon each side of a cut line using a surgical stapling and severinginstrument according to various embodiments of the present invention;

FIG. 34 is a diagrammatic representation of lines of staples installedon each side of a cut line using a surgical stapling and severinginstrument according to various embodiments of the present invention;

FIG. 35 is a side elevation section view of the surgical stapling andsevering instrument of FIG. 1 taken along the longitudinal centerline ofthe end effector in a partially closed but unclamped position grippingtissue according to various embodiments of the present invention;

FIG. 36 depicts a partially cut away side elevational view of thesurgical stapling and severing instrument of FIG. 1 in the closed orclamped position according to various embodiments of the presentinvention;

FIG. 37 depicts a side elevation view of the surgical stapling andsevering instrument of FIG. 1 in the closed or clamped position withtissue properly compressed according to various embodiments of thepresent invention;

FIG. 38 depicts a view in centerline section of the distal end of thesurgical stapling and severing instrument of FIG. 1 in a partially firedposition according to various embodiments of the present invention;

FIG. 39 depicts a partially cut away side elevation view of the surgicalstapling and severing instrument of FIG. 1 in a partially fired positionaccording to various embodiments of the present invention;

FIG. 40 depicts a view in centerline section of the distal end of thesurgical stapling and severing instrument of FIG. 1 in a fully firedposition according to various embodiments of the present invention;

FIG. 41 is a partially cut-away side elevational view of the surgicalstapling and severing instrument of FIG. 1 in a full fired positionaccording to various embodiments of the present invention;

FIGS. 42-44 depict aspects of an end effector having a sled withmultiple sled cams where one sled cam is taller than another accordingto various embodiments of the present invention;

FIG. 45 depicts aspects of an end effector with staple forming pocketshaving varying depths according to various embodiments of the presentinvention;

FIGS. 46-47 depict a double staple driver having staples of differentpre-formation lengths according to various embodiments of the presentinvention;

FIG. 48 depicts a side-view of an end effector having a double stapledriver having different staple driver heights according to variousembodiments of the present invention;

FIGS. 49-50 depict a side-view of an end effector having staple formingpockets of varying depths according to various embodiments of thepresent invention;

FIGS. 51-62 depict aspects of a surgical stapling device having stacksof actuatable wedge bands according to various embodiments of thepresent invention;

FIGS. 63-69 depict aspects of an open linear surgical stapling deviceaccording to various embodiments of the present invention;

FIGS. 70-77 depicts cross-sectional front views of an end effectoraccording to various embodiments of the present invention;

FIGS. 78-83 depict staple drivers that can accommodate staple havingdifferent wire diameters according to various embodiments of the presentinvention;

FIGS. 84-89 depict a circular surgical stapling device according tovarious embodiments of the present invention;

FIGS. 90-95 depict another surgical stapling device according toembodiments of the present invention;

FIG. 96 is a perspective view of one robotic controller embodiment;

FIG. 97 is a perspective view of one robotic surgical armcart/manipulator of a robotic system operably supporting a plurality ofsurgical tool embodiments of the present invention;

FIG. 98 is a side view of the robotic surgical arm cart/manipulatordepicted in FIG. 97;

FIG. 99 is a perspective view of an exemplary cart structure withpositioning linkages for operably supporting robotic manipulators thatmay be used with various surgical tool embodiments of the presentinvention;

FIG. 100 is a perspective view of a surgical tool embodiment of thepresent invention;

FIG. 101 is an exploded assembly view of an adapter and tool holderarrangement for attaching various surgical tool embodiments to a roboticsystem;

FIG. 102 is a side view of the adapter shown in FIG. 101;

FIG. 103 is a bottom view of the adapter shown in FIG. 101;

FIG. 104 is a top view of the adapter of FIGS. 101 and 102;

FIG. 105 is a partial bottom perspective view of the surgical toolembodiment of FIG. 100;

FIG. 106 is a partial exploded view of a portion of an articulatablesurgical end effector embodiment of the present invention;

FIG. 107 is a perspective view of the surgical tool embodiment of FIG.105 with the tool mounting housing removed;

FIG. 108 is a rear perspective view of the surgical tool embodiment ofFIG. 105 with the tool mounting housing removed;

FIG. 109 is a front perspective view of the surgical tool embodiment ofFIG. 105 with the tool mounting housing removed;

FIG. 110 is a partial exploded perspective view of the surgical toolembodiment of FIG. 105;

FIG. 111 is a partial cross-sectional side view of the surgical toolembodiment of FIG. 105;

FIG. 112 is an enlarged cross-sectional view of a portion of thesurgical tool depicted in FIG. 111;

FIG. 113 is an exploded perspective view of a portion of the toolmounting portion of the surgical tool embodiment depicted in FIG. 105;

FIG. 114 is an enlarged exploded perspective view of a portion of thetool mounting portion of FIG. 113;

FIG. 115 is a partial cross-sectional view of a portion of the elongatedshaft assembly of the surgical tool of FIG. 105;

FIG. 116 is a side view of a half portion of a closure nut embodiment ofa surgical tool embodiment of the present invention;

FIG. 117 is a perspective view of another surgical tool embodiment ofthe present invention;

FIG. 118 is a cross-sectional side view of a portion of the surgical endeffector and elongated shaft assembly of the surgical tool embodiment ofFIG. 117 with the anvil in the open position and the closure clutchassembly in a neutral position;

FIG. 119 is another cross-sectional side view of the surgical endeffector and elongated shaft assembly shown in FIG. 118 with the clutchassembly engaged in a closure position;

FIG. 120 is another cross-sectional side view of the surgical endeffector and elongated shaft assembly shown in FIG. 118 with the clutchassembly engaged in a firing position;

FIG. 121 is a top view of a portion of a tool mounting portionembodiment of the present invention;

FIG. 122 is a perspective view of another surgical tool embodiment ofthe present invention;

FIG. 123 is a cross-sectional side view of a portion of the surgical endeffector and elongated shaft assembly of the surgical tool embodiment ofFIG. 122 with the anvil in the open position;

FIG. 124 is another cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIG. 122 with the anvil in the closed position;

FIG. 125 is a perspective view of a closure drive nut and portion of aknife bar embodiment of the present invention;

FIG. 126 is a top view of another tool mounting portion embodiment ofthe present invention;

FIG. 127 is a perspective view of another surgical tool embodiment ofthe present invention;

FIG. 128 is a cross-sectional side view of a portion of the surgical endeffector and elongated shaft assembly of the surgical tool embodiment ofFIG. 127 with the anvil in the open position;

FIG. 129 is another cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIG. 128 with the anvil in the closed position;

FIG. 130 is a cross-sectional view of a mounting collar embodiment of asurgical tool embodiment of the present invention showing the knife barand distal end portion of the closure drive shaft;

FIG. 131 is a cross-sectional view of the mounting collar embodiment ofFIG. 130;

FIG. 132 is a top view of another tool mounting portion embodiment ofanother surgical tool embodiment of the present invention;

FIG. 132A is an exploded perspective view of a portion of a geararrangement of another surgical tool embodiment of the presentinvention;

FIG. 132B is a cross-sectional perspective view of the gear arrangementshown in FIG. 132A;

FIG. 133 is a cross-sectional side view of a portion of a surgical endeffector and elongated shaft assembly of another surgical toolembodiment of the present invention employing a pressure sensorarrangement with the anvil in the open position;

FIG. 134 is another cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIG. 133 with the anvil in the closed position;

FIG. 135 is a side view of a portion of another surgical tool embodimentof the present invention in relation to a tool holder portion of arobotic system with some of the components thereof shown incross-section;

FIG. 136 is a side view of a portion of another surgical tool embodimentof the present invention in relation to a tool holder portion of arobotic system with some of the components thereof shown incross-section;

FIG. 137 is a side view of a portion of another surgical tool embodimentof the present invention with some of the components thereof shown incross-section;

FIG. 138 is a side view of a portion of another surgical end effectorembodiment of a portion of a surgical tool embodiment of the presentinvention with some components thereof shown in cross-section;

FIG. 139 is a side view of a portion of another surgical end effectorembodiment of a portion of a surgical tool embodiment of the presentinvention with some components thereof shown in cross-section;

FIG. 140 is a side view of a portion of another surgical end effectorembodiment of a portion of a surgical tool embodiment of the presentinvention with some components thereof shown in cross-section;

FIG. 141 is an enlarged cross-sectional view of a portion of the endeffector of FIG. 140;

FIG. 142 is another cross-sectional view of a portion of the endeffector of FIGS. 140 and 141;

FIG. 143 is a cross-sectional side view of a portion of a surgical endeffector and elongated shaft assembly of another surgical toolembodiment of the present invention with the anvil in the open position;

FIG. 144 is an enlarged cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIG. 143;

FIG. 145 is another cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of FIGS. 143 and 144with the anvil thereof in the closed position;

FIG. 146 is an enlarged cross-sectional side view of a portion of thesurgical end effector and elongated shaft assembly of the surgical toolembodiment of FIGS. 143-145;

FIG. 147 is a top view of a tool mounting portion embodiment of asurgical tool embodiment of the present invention;

FIG. 148 is a perspective assembly view of another surgical toolembodiment of the present invention;

FIG. 149 is a front perspective view of a disposable loading unitarrangement that may be employed with various surgical tool embodimentsof the present invention;

FIG. 150 is a rear perspective view of the disposable loading unit ofFIG. 149;

FIG. 151 is a bottom perspective view of the disposable loading unit ofFIGS. 149 and 150;

FIG. 152 is a bottom perspective view of another disposable loading unitembodiment that may be employed with various surgical tool embodimentsof the present invention;

FIG. 153 is an exploded perspective view of a mounting portion of adisposable loading unit depicted in FIGS. 149-151;

FIG. 154 is a perspective view of a portion of a disposable loading unitand an elongated shaft assembly embodiment of a surgical tool embodimentof the present invention with the disposable loading unit in a firstposition;

FIG. 155 is another perspective view of a portion of the disposableloading unit and elongated shaft assembly of FIG. 154 with thedisposable loading unit in a second position;

FIG. 156 is a cross-sectional view of a portion of the disposableloading unit and elongated shaft assembly embodiment depicted in FIGS.154 and 154;

FIG. 157 is another cross-sectional view of the disposable loading unitand elongated shaft assembly embodiment depicted in FIGS. 154-156;

FIG. 158 is a partial exploded perspective view of a portion of anotherdisposable loading unit embodiment and an elongated shaft assemblyembodiment of a surgical tool embodiment of the present invention;

FIG. 159 is a partial exploded perspective view of a portion of anotherdisposable loading unit embodiment and an elongated shaft assemblyembodiment of a surgical tool embodiment of the present invention;

FIG. 160 is another partial exploded perspective view of the disposableloading unit embodiment and an elongated shaft assembly embodiment ofFIG. 159;

FIG. 161 is a top view of another tool mounting portion embodiment of asurgical tool embodiment of the present invention;

FIG. 162 is a side view of another surgical tool embodiment of thepresent invention with some of the components thereof shown incross-section and in relation to a robotic tool holder of a roboticsystem;

FIG. 163 is an exploded assembly view of a surgical end effectorembodiment that may be used in connection with various surgical toolembodiments of the present invention;

FIG. 164 is a side view of a portion of a cable-driven system fordriving a cutting instrument employed in various surgical end effectorembodiments of the present invention;

FIG. 165 is a top view of the cable-driven system and cutting instrumentof FIG. 164;

FIG. 166 is a top view of a cable drive transmission embodiment of thepresent invention in a closure position;

FIG. 167 is another top view of the cable drive transmission embodimentof FIG. 166 in a neutral position;

FIG. 168 is another top view of the cable drive transmission embodimentof FIGS. 166 and 167 in a firing position;

FIG. 169 is a perspective view of the cable drive transmissionembodiment in the position depicted in FIG. 166;

FIG. 170 is a perspective view of the cable drive transmissionembodiment in the position depicted in FIG. 167;

FIG. 171 is a perspective view of the cable drive transmissionembodiment in the position depicted in FIG. 168;

FIG. 172 is a perspective view of another surgical tool embodiment ofthe present invention;

FIG. 173 is a side view of a portion of another cable-driven systemembodiment for driving a cutting instrument employed in various surgicalend effector embodiments of the present invention;

FIG. 174 is a top view of the cable-driven system embodiment of FIG.173;

FIG. 175 is a top view of a tool mounting portion embodiment of anothersurgical tool embodiment of the present invention;

FIG. 176 is a top cross-sectional view of another surgical toolembodiment of the present invention;

FIG. 177 is a cross-sectional view of a portion of a surgical endeffector embodiment of a surgical tool embodiment of the presentinvention;

FIG. 178 is a cross-sectional end view of the surgical end effector ofFIG. 177 taken along line 178-178 in FIG. 177;

FIG. 179 is a perspective view of the surgical end effector of FIGS. 177and 178 with portions thereof shown in cross-section;

FIG. 180 is a side view of a portion of the surgical end effector ofFIGS. 177-179;

FIG. 181 is a perspective view of a sled assembly embodiment of varioussurgical tool embodiments of the present invention;

FIG. 182 is a cross-sectional view of the sled assembly embodiment ofFIG. 181 and a portion of the elongated channel of FIG. 180;

FIGS. 183-188 diagrammatically depict the sequential firing of staplesin a surgical tool embodiment of the present invention;

FIG. 189 is a partial perspective view of a portion of a surgical endeffector embodiment of the present invention;

FIG. 190 is a partial cross-sectional perspective view of a portion of asurgical end effector embodiment of a surgical tool embodiment of thepresent invention;

FIG. 191 is another partial cross-sectional perspective view of thesurgical end effector embodiment of FIG. 190 with a sled assemblyaxially advancing therethrough;

FIG. 192 is a perspective view of another sled assembly embodiment ofanother surgical tool embodiment of the present invention;

FIG. 193 is a partial top view of a portion of the surgical end effectorembodiment depicted in FIGS. 190 and 191 with the sled assembly axiallyadvancing therethrough;

FIG. 194 is another partial top view of the surgical end effectorembodiment of FIG. 193 with the top surface of the surgical staplecartridge omitted for clarity;

FIG. 195 is a partial cross-sectional side view of a rotary driverembodiment and staple pusher embodiment of the surgical end effectordepicted in FIGS. 190 and 191;

FIG. 196 is a perspective view of an automated reloading systemembodiment of the present invention with a surgical end effector inextractive engagement with the extraction system thereof;

FIG. 197 is another perspective view of the automated reloading systemembodiment depicted in FIG. 196;

FIG. 198 is a cross-sectional elevational view of the automatedreloading system embodiment depicted in FIGS. 196 and 197;

FIG. 199 is another cross-sectional elevational view of the automatedreloading system embodiment depicted in FIGS. 196-198 with theextraction system thereof removing a spent surgical staple cartridgefrom the surgical end effector;

FIG. 200 is another cross-sectional elevational view of the automatedreloading system embodiment depicted in FIGS. 196-199 illustrating theloading of a new surgical staple cartridge into a surgical end effector;

FIG. 201 is a perspective view of another automated reloading systemembodiment of the present invention with some components shown incross-section;

FIG. 202 is an exploded perspective view of a portion of the automatedreloading system embodiment of FIG. 201;

FIG. 203 is another exploded perspective view of the portion of theautomated reloading system embodiment depicted in FIG. 202;

FIG. 204 is a cross-sectional elevational view of the automatedreloading system embodiment of FIGS. 201-203;

FIG. 205 is a cross-sectional view of an orientation tube embodimentsupporting a disposable loading unit therein;

FIG. 206 is a perspective view of another surgical tool embodiment ofthe present invention;

FIG. 207 is a partial perspective view of an articulation jointembodiment of a surgical tool embodiment of the present invention;

FIG. 208 is a perspective view of a closure tube embodiment of asurgical tool embodiment of the present invention;

FIG. 209 is a perspective view of the closure tube embodiment of FIG.208 assembled on the articulation joint embodiment of FIG. 207;

FIG. 210 is a top view of a portion of a tool mounting portionembodiment of a surgical tool embodiment of the present invention;

FIG. 211 is a perspective view of an articulation drive assemblyembodiment employed in the tool mounting portion embodiment of FIG. 210;

FIG. 212 is a perspective view of another surgical tool embodiment ofthe present invention; and

FIG. 213 is a perspective view of another surgical tool embodiment ofthe present invention.

DETAILED DESCRIPTION

Applicant of the present application also owns the following patentapplications that were filed on May 27, 2011 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 13/118, 259, entitled “SurgicalInstrument With Wireless Communication Between a Control Unit of aRobotic System and Remote Sensor”;

U.S. patent application Ser. No. 13/118,210, entitled“Robotically-Controlled Disposable Motor Driven Loading Unit”;

U.S. patent application Ser. No. 13/118,194, entitled“Robotically-Controlled Endoscopic Accessory Channel”;

U.S. patent application Ser. No. 13/118,253, entitled“Robotically-Controlled Motorized Surgical Instrument”;

U.S. patent application Ser. No. 13/118,190, entitled“Robotically-Controlled Motorized Cutting and Fastening Instrument”;

U.S. patent application Ser. No. 13/118,223, entitled“Robotically-Controlled Shaft Based Rotary Drive Systems For SurgicalInstruments”;

U.S. patent application Ser. No. 13/118,263, entitled“Robotically-Controlled Surgical Instrument Having RecordingCapabilities”;

U.S. patent application Ser. No. 13/118,272, entitled“Robotically-Controlled Surgical Instrument With Force FeedbackCapabilities”;

U.S. patent application Ser. No. 13/118,246, entitled“Robotically-Driven Surgical Instrument With E-Beam Driver”;

U.S. patent application Ser. No. 13/118,241, entitled “Surgical StaplingInstruments With Rotatable Staple Deployment Arrangements”.

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the various embodiments of the present invention is definedsolely by the claims. The features illustrated or described inconnection with one exemplary embodiment may be combined with thefeatures of other embodiments. Such modifications and variations areintended to be included within the scope of the present invention.

Uses of the phrases “in various embodiments,” “in some embodiments,” “inone embodiment”, or “in an embodiment”, or the like, throughout thespecification are not necessarily all referring to the same embodiment.Furthermore, the particular features, structures, or characteristics ofone or more embodiments may be combined in any suitable manner in one ormore other embodiments. Such modifications and variations are intendedto be included within the scope of the present invention.

Turning to the figures, wherein like numerals denote like componentsthroughout the several views, FIGS. 1 and 2 depict one embodiment of asurgical stapling and severing instrument 10 that is capable ofpracticing the unique benefits of the present invention. It should berecognized, however, that the unique and novel aspects of the presentinvention may be advantageously employed in connection with a variety ofother staplers and stapler instruments without departing from the spiritand scope of the present invention. Accordingly, the scope of protectionafforded to the various embodiments of the present invention should notbe limited to use only with the specific type of surgical stapling andsevering instruments described herein.

As can be seen in FIGS. 1 and 2, the surgical stapling and severinginstrument 10 incorporates an end effector 12 having an actuator orE-beam firing mechanism (“firing bar”) 14 that advantageously controlsthe spacing of the end effector 12. In particular, an elongate channel16 and a pivotally translatable anvil 18 are maintained at a spacingthat assures effective stapling and severing. The problems are avoidedassociated with varying amounts of tissue being captured in the endeffector 12.

It will be appreciated that the terms “proximal” and “distal” are usedherein with reference to a clinician gripping a handle of an instrument.Thus, the end effector 12 is distal with respect to the more proximalhandle portion 20. It will be further appreciated that for convenienceand clarity, spatial terms such as “vertical” and “horizontal” are usedherein with respect to the drawings. However, surgical instruments areused in many orientations and positions, and these terms are notintended to be limiting and absolute.

The surgical and stapling and severing instrument 10 includes a handleportion 20 that is connected to an implement portion 22, the latterfurther comprising a shaft 23 distally terminating in the end effector12. The handle portion 20 includes a pistol grip 24 toward which aclosure trigger 26 is pivotally drawn by the clinician to causeclamping, or closing, of the anvil 18 toward the elongate channel 16 ofthe end effector 12. A firing trigger 28 is farther outboard of theclosure trigger 26 and is pivotally drawn by the clinician to cause thestapling and severing of clamped tissue in the end effector 12.

In practice, closure trigger 26 is actuated first. Once the clinician issatisfied with the positioning of the end effector 12, the clinician maydraw back the closure trigger 26 to its fully closed, locked positionproximate to the pistol grip 24. Then, the firing trigger 28 isactuated. The firing trigger 28 springedly returns when the clinicianremoves pressure. A release button 30 when depressed on the proximal endof the handle portion 20 releases any locked closure trigger 26.

A closure sleeve 32 encloses a frame 34, which in turn encloses a firingdrive member 36 that is positioned by the firing trigger 28. The frame34 connects the handle portion 20 to the end effector 12. With theclosure sleeve 32 withdrawn proximally by the closure trigger 26 asdepicted, the anvil 18 springedly opens, pivoting away from the elongatechannel 16 and translating proximally with the closure sleeve 32. Theelongate channel 16 receives a staple cartridge 37.

With particular reference to FIGS. 2-4, the firing bar 14 includes threevertically spaced pins that control the spacing of the end effector 12during firing. In particular, an upper pin 38 is staged to enter ananvil pocket 40 near the pivot between the anvil 18 and elongate channel16. When fired with the anvil 18 closed, the upper pin 38 advancesdistally within a longitudinal anvil slot 42 extending distally throughanvil 18. Any minor upward deflection in the anvil 18 is overcome by adownward force imparted by the upper pin 38. Firing bar 14 also includesa lowermost pin, or firing bar cap, 44 that upwardly engages a channelslot 45 in the elongate channel 16, thereby cooperating with the upperpin 38 to draw the anvil 18 and the elongate channel 16 slightly closertogether in the event of excess tissue clamped therebetween. The firingbar 14 advantageously includes a middle pin 46 that passes through afiring drive slot 47 formed in a lower surface of the cartridge 300 andan upward surface of the elongate channel 16, thereby driving thestaples therein as described below. The middle pin 46, by slidingagainst the elongate channel 16, advantageously resists any tendency forthe end effector 12 to be pinched shut at its distal end. To illustratean advantage of the middle pin 46, FIG. 5 depicts an alternative endeffector 12′ that lacks a middle pin on a firing bar 14′. In thisdepiction, the end effector 12′ is allowed to pinch shut at its distalend, which tends to impair desired staple formation.

Returning to FIGS. 2-4, a distally presented cutting edge 48 between theupper and middle pins 38, 46 on the firing bar 14 traverses through aproximally presented, vertical slot 49 in the cartridge 37 to severclamped tissue. The affirmative positioning of the firing bar 14 withregard to the elongate channel 16 and anvil 18 assure that an effectivecut is performed. The affirmative vertical spacing provided by theE-Beam firing bar 14 is suitable for the limited size available forendoscopic devices. Moreover, the E-Beam firing bar 14 enablesfabrication of an anvil 15 with a camber imparting a vertical deflectionat its distal end, similar to the position depicted in FIG. 5. Thiscambered anvil 15 advantageously assists in achieving the desired gap inthe end effector 12 even with an anvil 15 having a reduced thickness,which may be more suited to the size limitations of an endoscopicdevice.

With reference to FIGS. 6-9, the handle portion 20 is comprised of firstand second base sections 50 and 52, which are molded from a polymericmaterial such as a glass-filled polycarbonate. The first base section 50is provided with a plurality of cylindrically-shaped pins 54. The secondbase section 52 includes a plurality of extending members 56, eachhaving a hexagonal-shaped opening 58. The cylindrically-shaped pins 54are received within the hexagonal-shaped openings 58 and arefrictionally held therein for maintaining the first and second basesections 50 and 52 in assembly.

A rotating knob 60 has a bore 62 extending completely through it forengaging and rotating the implement portion 22 about its longitudinalaxis. The rotating knob 60 includes an inwardly protruding boss 64extending along at least a portion of the bore 62. The protruding boss64 is received within a longitudinal slot 66 formed at a proximalportion of the closure sleeve 32 such that rotation of the rotating knob60 effects rotation of the closure sleeve 32. It will be appreciatedthat the boss 64 further extends through frame 34 and into contact witha portion of the firing drive member 36 to effect their rotation aswell. Thus, the end effector 12 (not shown in FIGS. 6-9) rotates withthe rotating knob 60.

A proximal end 68 of the frame 34 passes proximally through the rotatingknob 60 and is provided with a circumferential notch 70 that is engagedby opposing channel securement members 72 extending respectively fromthe base sections 50 and 52. Only the channel securement member 72 ofthe second base section 52 is shown. The channel securement members 72,extending from the base sections 50, 52 serve to secure the frame 34 tothe handle portion 20 such that the frame 34 does not movelongitudinally relative to the handle portion 20.

The closure trigger 26 has a handle section 74, a gear segment section76, and an intermediate section 78. A bore 80 extends through theintermediate section 78. A cylindrical support member 82 extending fromthe second base section 52 passes through the bore 80 for pivotablymounting the closure trigger 26 on the handle portion 20. A secondcylindrical support member 83 extending from the second base section 52passes through a bore 81 of firing trigger 28 for pivotally mounting onthe handle portion 20. A hexagonal opening 84 is provided in thecylindrical support member 83 for receiving a securement pin (not shown)extending from the first base section 50.

A closure yoke 86 is housed within the handle portion 20 forreciprocating movement therein and serves to transfer motion from theclosure trigger 26 to the closure sleeve 32. Support members 88extending from the second base section 52 and securement member 72,which extends through a recess 89 in the yoke 86, support the yoke 86within the handle portion 20.

A proximal end 90 of the closure sleeve 32 is provided with a flange 92that is snap-fitted into a receiving recess 94 formed in a distal end 96of the yoke 86. A proximal end 98 of the yoke 86 has a gear rack 100that is engaged by the gear segment section 76 of the closure trigger26. When the closure trigger 26 is moved toward the pistol grip 24 ofthe handle portion 20, the yoke 86 and, hence, the closure sleeve 32move distally, compressing a spring 102 that biases the yoke 86proximally. Distal movement of the closure sleeve 32 effects pivotaltranslation movement of the anvil 18 distally and toward the elongatechannel 16 of the end effector 12 and proximal movement effects closing,as discussed below.

The closure trigger 26 is forward biased to an open position by a frontsurface 130 interacting with an engaging surface 128 of the firingtrigger 28. Clamp first hook 104 that pivots top to rear in the handleportion 20 about a pin 106 restrains movement of the firing trigger 28toward the pistol grip 24 until the closure trigger 26 is clamped to itsclosed position. Hook 104 restrains firing trigger 28 motion by engaginga lockout pin 107 in firing trigger 28. The hook 104 is also in contactwith the closure trigger 26. In particular, a forward projection 108 ofthe hook 104 engages a member 110 on the intermediate section 78 of theclosure trigger 26, the member 100 being outward of the bore 80 towardthe handle section 74. Hook 104 is biased toward contact with member 110of the closure trigger 26 and engagement with lockout pin 107 in firingtrigger 28 by a release spring 112. As the closure trigger 26 isdepressed, the hook 104 is moved top to rear, compressing the releasespring 112 that is captured between a rearward projection 114 on thehook 104 and a forward projection 116 on the release button 30. As theyoke 86 moves distally in response to proximal movement of the closuretrigger 26, an upper latch arm 118 of the release button 30 moves alongan upper surface 120 on the yoke 86 until dropping into an upwardlypresented recess 122 in a proximal, lower portion of the yoke 86. Therelease spring 112 urges the release button 30 outward, which pivots theupper latch arm 118 downwardly into engagement with the upwardlypresented recess 122, thereby locking the closure trigger 26 in a tissueclamping position, such as depicted in FIG. 8.

The latch arm 118 can be moved out of the recess 122 to release theanvil 18 by pushing the release button 30 inward. Specifically, theupper latch arm 118 pivots upward about pin 123 of the second basesection 52. The yoke 86 is then permitted to move proximally in responseto return movement of the closure trigger 26.

A firing trigger return spring 124 is located within the handle portion20 with one end attached to pin 106 of the second base section 52 andthe other end attached to a pin 126 on the firing trigger 28. The firingreturn spring 124 applies a return force to the pin 126 for biasing thefiring trigger 28 in a direction away from the pistol grip 24 of thehandle portion 20. The closure trigger 26 is also biased away frompistol grip 24 by engaging surface 128 of firing trigger 28 biasingfront surface 130 of closure trigger 26.

As the closure trigger 26 is moved toward the pistol grip 24, its frontsurface 130 engages with the engaging surface 128 on the firing trigger28 causing the firing trigger 28 to move to its “firing” position. Whenin its firing position, the firing trigger 28 is located at an angle ofapproximately 45° to the pistol grip 24. After staple firing, the spring124 causes the firing trigger 28 to return to its initial position.During the return movement of the firing trigger 28, its engagingsurface 128 pushes against the front surface 130 of the closure trigger26 causing the closure trigger 26 to return to its initial position. Astop member 132 extends from the second base section 52 to prevent theclosure trigger 26 from rotating beyond its initial position.

The surgical stapling and severing instrument 10 additionally includes areciprocating section 134, a multiplier 136 and a drive member 138. Thereciprocating section 134 comprises a wedge sled in the implementportion 22 (not shown in FIGS. 6-9) and a metal drive rod 140. The drivemember 138 includes first and second gear racks 141 and 142. A firstnotch 144 is provided on the drive member 138 intermediate the first andsecond gear racks 141, 142. During return movement of the firing trigger28, a tooth 146 on the firing trigger 28 engages with the first notch144 for returning the drive member 138 to its initial position afterstaple firing. A second notch 148 is located at a proximal end of themetal drive rod 140 for locking the metal drive rod 140 to the upperlatch arm 118 of the release button 30 in its unfired position. Themultiplier 136 comprises first and second integral pinion gears 150 and152. The first integral pinion gear 150 is engaged with a first gearrack 154 provided on the metal drive rod 140. The second integral piniongear 152 is engaged with the first gear rack 141 on the drive member138. The first integral pinion gear 150 has a first diameter and thesecond integral pinion gear 152 has a second diameter which is smallerthan the first diameter.

FIGS. 6, 8 and 9 depict respectively the handle portion 20 in the startposition (open and unfired), a clamped position (closed and unfired) anda fired position. The firing trigger 28 is provided with a gear segmentsection 156. The gear segment section 156 engages with the second gearrack 142 on the drive member 138 such that motion of the firing trigger28 causes the drive member 138 to move back and forth between a firstdrive position, shown in FIG. 8, and a second drive position, shown inFIG. 9. In order to prevent staple firing before tissue clamping hasoccurred, the upper latch arm 118 on the release button 39 is engagedwith the second notch 148 on the drive member 138 such that the metaldrive rod 140 is locked in its proximal-most position, as depicted inFIG. 6. When the upper latch arm 118 falls into the recess 122, theupper latch arm 118 disengages with the second notch 148 to permitdistal movement of the metal drive rod 140, as depicted in FIG. 9.

Because the first gear rack 141 on the drive member 138 and the gearrack 154 on the metal drive rod 140 are engaged with the multiplier 136,movement of the firing trigger 28 causes the metal drive rod 140 toreciprocate between a first reciprocating position, shown in FIG. 8, anda second reciprocating position, shown in FIG. 9. Since the diameter ofthe first pinion gear 150 is greater than the diameter of the secondpinion gear 152, the multiplier 136 moves the reciprocating section 134a greater distance than the drive member 138 is moved by the firingtrigger 28. The diameters of the first and second pinion gears 150 and152 may be changed to permit the length of the stroke of the firingtrigger 28 and the force required to move it to be varied. It will beappreciated that the handle portion 20 is illustrative and that otheractuation mechanisms may be employed. For instance, the closing andfiring motions may be generated by automated means.

One embodiment of an end effector 12 of the surgical stapling andsevering instrument 10 is depicted in further detail in FIGS. 18, 19,and 23-26. As described above, the handle portion 20 produces separateand distinct closing and firing motions that actuate the end effector12. The end effector 12 advantageously maintains the clinicalflexibility of this separate and distinct closing and firing (i.e.,stapling and severing). In addition, the end effector 12 introduces theaforementioned ability to affirmatively maintain the closed spacingduring firing after the clinician positions and clamps the tissue. Bothfeatures procedurally and structurally enhance the ability of thesurgical stapling and severing instrument 10 by ensuring adequatespacing for instances where an otherwise inadequate amount of tissue isclamped and to enhance the clamping in instances where an otherwiseexcessive amount of tissue has been clamped.

FIG. 10 depicts a staple cartridge embodiment 300 of the presentinvention installed in the end effector 12 with the firing bar 14 in itsunfired, proximal position. The staple cartridge 300 has a cartridgebody 302 that is divided by an elongated slot 310 that extends from aproximal end 304 of the cartridge 300 towards a tapered outer tip 306. Aplurality of staple-receiving channels 320 a-320 f are formed within thestaple cartridge body 302 and are arranged in six laterally spacedlongitudinal rows 500, 502, 504, 506, 508, 510, with three rows on eachside of the elongated slot 310. Positioned within the staple-receivingchannels 320 a-320 f are the staples 222. See FIGS. 10 and 11.

The cartridge 300 further includes four laterally spaced longitudinalrows of staple drivers 330 a, 330 b, 370 a, and 370 b as shown in FIG.11. The “first” inside staple drivers 330 a are slidably mounted withincorresponding channels 320 b and 320 c such that each driver 330 asupports two staples 222, one in a channel 320 b and one in a channel320 c. Likewise, the “second” inside drivers 330 b are slidably mountedwithin channels 320 d and 320 e such that each driver 330 b supports twostaples 222, one in a channel 320 d and one in a channel 320 e. The“outside” drivers 370 a and 370 b are slidably mounted within thestaple-receiving channels 320 a and 320 f, respectively. Each of theoutside drivers 370 a and 370 b supports a single staple 222. Drivers370 a are referred to herein as “first” outside drivers and drivers 370b are referred to herein as “second” outside drivers.

FIG. 12 illustrates a staple 222 that may be used in connection with thevarious embodiments of the present invention. The staple 222 includes amain portion 223 and two prongs 225. The prongs 225 each have a length“P” and the main portion has a width “W”. The reader will appreciatethat a variety of different types of staples may be employed. Forexample, for a vascular staple, “P” may be approximately 0.102 inches;for a regular staple, “P” may be approximately 0.134 inches; and for athick tissue staple, “P” may be approximately 0.160 inches. “W” may beapproximately 0.012 inches. Other sizes of staples 222 may be employedin the manners discussed below.

The inside staple drivers 330 a located on one side of the elongatedslot 310 are referred to herein as “first” inside staple drivers and theinside staple drivers 330 b located on the other side of the elongatedslot 310 are referred to herein as “second” inside staple drivers. Aswill be discussed in further detail below, in one embodiment, the secondinside staple drivers 330 b are identical to the first inside stapledrivers 330 a, except for their orientation in their respective channelsin the cartridge body 302.

FIGS. 13-15 illustrate one embodiment of a “first” inside double driver330 a for supporting and driving staples 222. As can be seen in thoseFigures, the staple driver 330 a has a primary driver portion 340 and asecondary driver portion 350 that is connected to the first primaryportion 340 by a central base member 360. The primary driver portion 340has a primary driver base 342 that has a groove 343 therein adapted tomate with a corresponding vertically extending tongue (not shown) in thecartridge body 302 for guiding and stabilizing the driver 330 a as itmoves within its respective channel. The primary driver portion 340further has a first forward support column 344 and a first rearwardsupport column 346 protruding upward from the first driver base 342. Thefirst forward support column 344 has a first forward staple-receivinggroove 345 therein and the first rearward support column 346 has a firstrearwardly staple-receiving groove 347 therein. See FIGS. 13-15. Thefirst forward support column 344 and the first rearward support column346 are spaced from each other and collectively form a first staplecradle 348 for supporting the main portion 223 of the staple 222 thereinin an upright position (i.e., prongs facing the anvil). Similarly, thesecondary driver portion 350 has a secondary driver base 352 and asecondary forward support column 354 and a secondary rearward supportcolumn 356 protruding out from the second driver base 352. The secondaryforward support column 354 has a secondary forward staple-receivinggroove 355 therein and the secondary rearward support column 356 has asecondary rearward staple-receiving groove 357 therein. The secondaryforward support column 354 and the secondary rearward support column 356are spaced from each other and collectively form a secondary staplecradle 358 for supporting the main portion 223 of another staple 222therein.

As can be seen in FIGS. 13 and 15, the central base member 360 has anangled rearwardly facing edge 362 adapted to be engaged by acorresponding sled cam as will be discussed in further detail below. Ascan be seen in FIGS. 13 and 14, in this embodiment, the secondaryforward support column 354 of the secondary driver portion is orientedrelative to the first rearward support column 346 such that the staple222 that is supported in the secondary staple cradle 358 islongitudinally offset from the staple 222 in the first staple cradle348. The reader will appreciate that the first inside drivers 330 a areeach installed in one orientation into a corresponding pair of channels320 b and 320 c located on one side of the elongated slot 310 in thecartridge body 302. The second inside staple drivers 330 b (located onthe opposite side of the elongated slot 310 from the first inside stapledrivers 330 a) comprise inside drivers 330 a rotated 180 degrees so thattheir respective angled surfaces 363 face towards the proximal end 304of the cartridge 300 to enable them to be installed in pairs ofcorresponding channels 320 d and 320 e. Thus, in this embodiment, onlyone inside driver configuration is employed which thereby eliminates theneed for two different inside staple driver configurations for channelson each side of the elongated slot 310.

FIGS. 16 and 17 illustrate one embodiment of a “first” outside stapledriver 370 a. As can be seen in those Figures, a first outside stapledriver 370 a has a second base 372 that has an angled rearwardly facingportion 374. Protruding upward from the second base 372 is a secondforward support column 375 that has a second forward staple-receivinggroove 376 therein. A second rearward support column 377 also protrudesupward from the second base 372 in a spaced-apart relationship withrespect to the second forward support column 375. The second rearwardsupport column 377 has a second rearward staple-receiving groove 378therein. The support columns 375, 377 collectively form a second staplecradle 379 that is configured to support a staple 222 therein in anupright position as illustrated in FIGS. 16 and 17. The staple drivers370 a also have a laterally protruding rib 371 which is received in acorresponding groove (not shown) in the cartridge body 302 for guidingand stabilizing the driver 370 a as it moves within its respectivechannel.

The reader will appreciate that a first outside driver 370 a isinstalled in one orientation into a corresponding channel 320 a on oneside of the elongated slot 310. A second outside staple driver 370 b (tobe located on the opposite side of the elongated slot 310 from the firstoutside staple drivers 370 a) comprises an outside driver 370 a rotated180 degrees so that the angled surface 374′ thereon faces toward theproximal end 304 of the cartridge 300 to enable it to be installed in acorresponding channel 320 f in the cartridge body 302. Thus, in thisembodiment, only one outside staple driver configuration is employedwhich avoids the need for two different outside staple driverconfigurations for channels on each side of the elongated slot 310.FIGS. 19 and 19A illustrate in cross-section one embodiment of a staplecartridge of the present invention mounted within one type of endeffector 12. The end effector 12 in this embodiment employs a “stepped”anvil 18 of the type illustrated in FIGS. 23-25. In other embodiments,however, the bottom surface of the anvil is planar and not stepped. Ascan be seen in FIGS. 19A, and 23-25, the anvil 18 has a central portion19 that is offset or not coplanar with the two lateral side portions 21,23. Accordingly, in this embodiment, the upper surface 306 of thecartridge 300 is provided with a recessed central portion 307 and twolateral side portions 309 that are adapted to closely mate with thecorresponding portions 19, 21, 23, respectively, of the anvil 18, whenthe anvil 18 is in the closed position. See FIG. 19A.

As can be seen in FIG. 24, in this embodiment, the under surfaces 200 ofanvil 18 are provided with a series of forming pockets 202 that may bearranged in rows that correspond to the rows of channels in thecartridge 300. That is, row 205 of pockets 202 may correspond to channelrow 500. Row 207 of pockets may correspond to channel row 502. Row 209of pockets 202 may correspond to channel row 504. Row 211 of pockets 202may correspond to channel row 506. Row 213 of pockets 202 may correspondto channel row 508. Row 215 of pockets 202 may correspond to channel row510. Each pocket 202 has at least one forming surface 203 therein thatis adapted to contact the ends of the staple prongs 225 being driventherein to thereby cause the prongs 225 to bend inwardly toward eachother. In one embodiment, each pocket 202 has two intersecting arcuateforming surfaces 203 that are oriented as shown in FIG. 14A. Eacharcuate forming surface has an apex 203′ that defines a maximum pocketdepth “Z”. However other forming pocket configurations could beemployed.

Returning to FIGS. 18 and 19, it can be seen that in one embodiment, thecartridge body 302 is mounted within the cartridge tray 224. Asillustrated in FIG. 19, the cartridge body 302 is formed with two insidelongitudinally extending slots 390 and two outside longitudinallyextending slots 392. Slots 390 and 392 extend from the proximal end 304of the cartridge to its tapered outer tip 306 (shown in FIG. 10). Thisembodiment further includes a wedge sled 400 that slidably supported onthe cartridge tray 224. One wedge sled embodiment 400 includes a pair ofinside sled cams 410, wherein one inside sled cam 410 corresponds to oneof the inside longitudinally extending slots 390 and wherein the otherinside sled cam 410 corresponds to the other inside longitudinallyextending slot 390. See FIG. 19. The wedge sled 400 further includes apair of outside sled cams 420, wherein one outside sled cam 420corresponds to one of the outside longitudinally extending slots 392 andthe other outside sled cam 420 corresponds to the other outsidelongitudinally extending slot 392 as shown in FIG. 19. When assembled,the cartridge tray 224 holds the wedge sled 400 and the drivers 330 a,330 b, 370 a, 370 b inside the cartridge body 302.

As can be seen in FIG. 18, the elongate channel 16 has a proximallyplaced attachment cavity 226 that receives a channel anchoring member228 on the distal end of the frame 34 for attaching the end effector 12to the handle portion 20. The elongate channel 16 also has an anvil camslot 230 that pivotally receives an anvil pivot 232 of the anvil 18. Theclosure sleeve 32 that encompasses the frame 34 includes a distallypresented tab 234 that engages an anvil feature 236 proximate but distalto the anvil pivot 232 on the anvil 18 to thereby effect opening andclosing of the anvil 18. The firing drive member 36 is shown as beingassembled from the firing bar 14 attached to a firing connector 238 bypins 240, which in turn is rotatingly and proximally attached to themetal drive rod 140. The firing bar 14 is guided at a distal end of theframe by a slotted guide 239 inserted therein.

FIGS. 20-23 illustrate one embodiment of the wedge sled 400 of thepresent invention. As can be seen in FIGS. 20 and 23, the wedge sled 400includes a central spacer portion 402 that extends between the insidesled cams 410. A pusher block 404 is formed on the central spacerportion 402 for engagement with the middle pin 46 of the firing bar 14.A side profile of one embodiment of an inside sled cam 410 is depictedin FIG. 21. As can be seen in that Figure, the inside sled cam 410 has abottom surface 412, and a first camming surface 414 that forms an angle“G” with the bottom surface 412 and a second camming surface 415 thatextends to a top surface 416. In one embodiment, for example, the angle“G” may be 35 degrees and the angle “G′” may be 20 degrees. The heightof the inside sled cam 410 (the distance between the bottom surface 412and the top surface 416) is represented as “first” sled cam height “H”.In one embodiment, distance “H′ is approximately 0.173 inches and thelength of the top surface 416 may vary from embodiment to embodiment. Aswill be further evident as the present Detailed Description proceeds,the first sled cam height represents the vertical distance that theinside sled cams 410 will drive the corresponding inside drivers 330 a,330 b toward the anvil 18 during operation.

The wedge sled 400 further comprises lateral spacer portions 406 thatextend between the inside sled cams 410 and the outside sled cams 420 asshown in FIGS. 20 and 23. A side profile of one embodiment of an outsidesled cam 420 is depicted in FIG. 22. In this embodiment, the outsidesled cam 420 has a bottom surface 422 and a first camming surface 424that forms an angle “I” with respect to the bottom surface 422 and asecond camming surface 425 that to a top surface 426. In one embodiment,angle “I” may be approximately 35 degrees and angle “I” may beapproximately 20 degrees. The height of the outside sled cam 420 (thedistance between the bottom surface 412 and the top surface 416) isrepresented as the “second” sled cam height “J”. In one embodiment,distance “J′ is approximately 0.163 inches. The second sled cam heightrepresents the vertical distance that the outside sled cams 420 willdrive the corresponding outside drivers 370 a, 370 b toward the anvil 18during operation. The reader will understand that the above-reciteddimensions are illustrative of one embodiment and may vary for otherembodiments.

With particular reference to FIG. 23, a portion of the staple cartridge300 is removed to expose portions of the elongate channel 16, such asrecesses 212, 214 and to expose some components of the staple cartridge300 in their unfired position. In particular, the cartridge body 302(shown in FIG. 18) has been removed. The wedge sled 400 is shown at itsproximal, unfired position with a pusher block 404 contacting the middlepin 46 (not shown in FIG. 23) of the firing bar 14. The wedge sled 400is in longitudinal sliding contact upon the cartridge tray 224 andincludes wedges sled cams 410, 420 that force upward the double drivers330 a, 330 b and the single drivers 370 b, 370 b as the wedge sled 400moves distally. Staples 222 (not shown in FIG. 23) resting upon thedrivers 330 a, 330 b, 370 a, 370 b are thus also forced upward intocontact with the anvil forming pockets 202 in anvil 18 to form closedstaples. Also depicted is the channel slot 45 in the elongate channel 16that is aligned with the elongated slot 310 in the staple cartridge 300.

FIG. 24 depicts the end effector 12, which is in an open position by aretracted closure sleeve 32, with a staple cartridge 300 installed inthe elongate channel 16. The firing bar 14 is at its proximal position,with the upper pin 38 aligned in a non-interfering fashion with theanvil pocket 40. The anvil pocket 40 is shown as communicating with thelongitudinal anvil slot 42 in the anvil 18. The distally presentedcutting edge 48 of the firing bar 14 is aligned with and proximally fromremoved from the vertical slot 49 in the staple cartridge 300, therebyallowing removal of a spent cartridge and insertion of an unfiredcartridge, which may be “snapfit” into the elongate channel 16.Specifically, in this embodiment, extension features 316, 318 of thestaple cartridge 300 engage recesses 212, 214, respectively (shown inFIG. 23) of the elongate channel 16.

FIG. 25 depicts the end effector 12 of FIG. 23 with all of the staplecartridge 300 removed to show the middle pin 46 of the firing bar 14 aswell as portion of the elongate channel 16 removed adjacent to thechannel slot 45 to expose the firing bar cap 44. In addition, portionsof the shaft 23 are removed to expose a proximal portion of the firingbar 14. Projecting downward from the anvil 18 near the pivot is a pairof opposing tissue stops 244 which serve to prevent tissue from beingpositioned too far up into the end effector 12 during clamping. FIG. 26depicts the end effector 12 in a closed position with the firing bar 14in an unfired position. The upper pin 38 is in the anvil pocket 40 andis vertically aligned with the anvil slot 42 for distal longitudinalmovement of the firing bar 14 during firing. The middle pin 46 ispositioned to push the wedge sled 400 distally so that the sled cams410, 420 contact and lift double drivers 330 a, 330 b and the singledrivers 370 a, 370 b, respectively, to drive them upwardly toward theanvil 18.

As can be appreciated from reference to FIGS. 14A, 15A and 19A, in oneembodiment of the present invention, the distance between the bottom ofthe first staple-receiving grooves 345, 347 forming the first staplecradle 349 and the apex 203′ of forming surfaces 203 of thecorresponding forming pocket 202 of anvil 18, when the anvil 18 is inthe closed position and when the inside driver 330 a, 330 b is supportedon the cartridge tray 224, is referred to herein as the first stapleforming distance “A”. The distance between the bottom of the secondarystaple-receiving grooves 345, 347 forming the secondary staple cradle349 and the apex 203′ of the forming surface 203 of the correspondingforming pocket 202 in the anvil 18 when the anvil 18 is in the closedposition and the inside driver 330 a, 330 b is supported on thecartridge tray 224 is referred to herein as the secondary staple formingdistance “B”. In one embodiment, the first staple forming distance “A”and the secondary staple forming distance “B” are substantially equal toeach other. In other embodiments, those distances “A” and “B” may differfrom each other.

As illustrated in FIGS. 16A and 19A the distance between the bottom ofthe second staple-receiving grooves 376, 378 that form the second staplecradle 379 and the apex 203′ of the forming surface 203 of acorresponding forming pocket 202 in anvil 18 when the anvil 18 is in theclosed position and the outside drivers 370 a, 370 b are supported onthe cartridge channel 224, is referred to herein as a “second” stapleforming distance “C”.

FIGS. 27 and 28 illustrate the forming of staples supported on some ofthe first outside drivers 370 a. In FIG. 27, one of the outside sledcams 420 of the wedge sled 400 is initially contacting one of theoutside drivers 370 a. As the wedge sled 400 continues in the drivingdirection represented by arrow “K” in FIG. 28, the outside sled cam 420causes the outside drivers 370 a drive the staples 222 supported therebyinto the staple forming pockets 202 in the anvil 18. Likewise, as thewedge sled 400 is driven in the driving direction “K”, the inside sledcams 410 contact the inside drivers 330 a, 330 b and causes them todrive the staples 222 supported thereby into the corresponding stapleforming pockets 202 in the anvil 18.

As indicated above, in some applications involving an area of variedtissue composition, it can be desirable to form rows of staples whereinthe formed (final) heights of the staples in a row that is the farthestdistance away from the cut line are greater than the formed (final)heights of those staples in the row that is closest to the cut line. Inother applications, it may be desirable for the formed heights of thestaples in a single row to increase (or decrease) from staple to staple.Another clinical benefit would be to have the formed heights of thestaples in the outermost rows larger than formed heights of the staplesin the inside rows. The various embodiments of the subject invention canprovide these results while employing identical staples in all of therows.

In the description to follow, those staples 222 in the outermost rows520, 530 of staples (those staples formed using the outside stapledrivers 370 a, 370 b) will be referred to hereinafter as staples 222′and those staples in the innermost rows 522, 524, 526, 528 of staples(those staples formed using the inside staple drivers 330 a, 330 b) willbe referred to hereinafter as staples 222″. It will be understood,however, that staples 222′ and 222″ are identical to each other prior tobeing formed by the various embodiments of the present invention. Thatis, staples 222′ and 222″ each have identical prong lengths “P” andwidths “W”. Returning to FIGS. 14A-16A and 21 and 22, the above desiredeffects may be attained by altering the staple forming distances “A”,“B”, and “C” relative to each other and/or the sled cam heights “H” and“J”. In one embodiment of the subject invention, for example, the height“H” of each of the inside sled cams 410 is substantially equal to thesled height “J” of each of the outside sled cams 420. See FIGS. 21 and22. In this embodiment, the staple forming distances “A” and “B” aresubstantially equal to each other, but distances “A” and “B” are lessthan the staple forming distance “C”. The distance “D” between thebottoms of the first staple-receiving grooves 345, 347 and the bottomsurface 342′ of the primary driver base 342 is substantially equal tothe distance “E” between the bottoms of the secondary staple-receivinggrooves 356, 357 and the bottom surface 352′ of the secondary driverbase portion 352. See FIG. 15. Also in this embodiment, the distance “F”between the bottoms of the second staple-receiving grooves 376 and 378and the bottom surface 373 of the third base 372 of the outside drivers370 a, 370 b (FIG. 16) is less than distances “D” and “E” (FIG. 15).Because the forming distance “C” is greater than the forming distances“A” and “B”, the staples 222 supported and formed by the outside drivers370 a, 370 b are not compressed as much as the staples supported andformed by the inside drivers 330 a, 330 b. It will be understood thatsimilar results may be attained on the opposite side of the elongatedslot 310 and the cut line 600 formed in the tissue by using the samearrangements and sizes of inside drivers 330 b and outside drivers 370b. In an alternative embodiment, the same effect may be achieved byaltering the depths of the forming pockets 202 corresponding to thedrivers 330 a and 370 b such that forming distance “C” is greater thanthe forming distances “”A” and “B”. That is, the depth (distance “Z′” inFIG. 16A) of the forming pockets 202 corresponding to the outsidedrivers 370 a. 370 b may be greater than the depth (distance “Z” in FIG.14A) of the forming pockets 202 that correspond to the inside drivers330 a, 330 b.

FIG. 29 illustrates the rows of staples formed on each side of a cutline 600 utilizing this embodiment of the present invention wherein theforming distances “A” and “B” are equal to each other and the formingdistance “C” is greater than the forming distances “A” and “B”. Forexample, if forming distance “C” is 0.020″ greater than formingdistances “A” and “B”, the formed height of the outside staples 222′(represented as dimension “L” in FIG. 30) in rows 520 and 530 would be0.020 inches is greater than the formed height of the inside staples222″ (represented as dimension “M” in FIG. 31) in rows 522, 524, 526,528.

The same result may be achieved by utilizing another embodiment of thepresent invention wherein the forming distances “A”, “B” and “C” areessentially equal. In this embodiment, however, the height of each ofthe inside sled cams 410 (distance “H” in FIG. 21) is greater than theheight of each of the outside sled cams 420 (distance “J” in FIG. 22).Thus, because the height “H” of the inside sled cams 410 is greater thanthe height “J′” of the outside sled cams 420, the inside sled cams 410will drive the corresponding inside drivers 330 a, 330 b further towardsthe anvil than the outside sled cams 420 will drive the correspondingoutside drivers 370 a, 370 b. Such driving action will cause the staplessupported by the inside drivers 330 a, 330 b to be compressed to agreater extent than those staples supported by the outside drivers 370a, 370 b. For example, if distance “H” is 0.020 inches greater thandistance “J”, the formed height of staples 222′ in lines 520, 530 wouldbe 0.020″ greater than the formed height of staples 222″ in lines 522,524, 526, 528.

When employing yet another embodiment of the present invention, theoutside rows 520, 530 of staples 222′ and the inside rows 522, 528 ofstaples 222″ may be formed with heights that are greater than the formedheights of the staples 222″ in the inside rows 524, 526. See FIG. 32.This result is achieved by making the forming distances “C” greater thanthe forming distance “A” and making forming distance “A” greater thansecondary forming distance “B”.

Another embodiment of the present invention can be used to installstaples where it is desirable for the formed heights of staples in asingle row to vary. One such arrangement is depicted in FIG. 33. As canbe seen in FIG. 33, the formed heights of the staples 222′ in theoutside rows 520, 530 increase when moving from the proximal ends 521,531 of each row 520, 530, respectively to the distal ends 523, 533 ofeach row 520, 530, respectively. This effect may be accomplished bydecreasing the forming distance “C” for each succeeding driver 370 a,370 b. That is, the driver 370 a closest the proximal end of thecartridge 300 would be sized to establish a forming distance “C” that isgreater than the forming distance “C” achieved by the adjacent driver370 a and so on to achieve a condition wherein each succeeding staple222′ (moving in the direction from the proximal end to the distal end ofthe cartridge 300) would have larger formed heights. This result couldalso be attained in the staples 222″ in rows 522, 524, 526, 528 bysimilarly altering the forming distances “A” and/or “B” attained by eachdriver 330 a, 330 b. Likewise, formed heights of the staples 222′ in theoutside rows 520, 530 could be made to decrease when moving from theproximal ends 521, 531 of each row 520, 530, respectively, to the distalends 523, 533 of each row 520, 530, respectively. This result may beattained by increasing the forming distance of each succeeding driver370 a, 370 b. That is, the driver 370 a closest the proximal end of thecartridge 300 would have a forming distance “C” that is less than theforming distance “C” of the adjacent driver 370 a and so on to achieve acondition wherein each succeeding staple 222′ (moving in the directionfrom the proximal end to the distal end of the cartridge) would havesmaller formed heights. See FIG. 34.

In use, the surgical stapling and severing instrument 10 is used asdepicted in FIGS. 1-2 and 35-41. In FIGS. 1-2, the instrument 10 is inits start position, having had an unfired, fully loaded staple cartridge300 snap-fitted into the distal end of the elongate channel 16. Bothtriggers 26, 28 are forward and the end effector 12 is open, such aswould be typical after inserting the end effector 12 through a trocar orother opening into a body cavity. The instrument 10 is then manipulatedby the clinician such that tissue 248 to be stapled and severed ispositioned between the staple cartridge 300 and the anvil 18, asdepicted in FIG. 35. With reference to FIGS. 36 and 37, the clinicianthen moves the closure trigger 26 proximally until positioned directlyadjacent to the pistol grip 24, locking the handle portion 20 into theclosed and clamped position. The retracted firing bar 14 in the endeffector 12 does not impede the selective opening and closing of the endeffector 12, but rather resides within the anvil pocket 40. With theanvil 18 closed and clamped, the E-beam firing bar 14 is aligned forfiring through the end effector 12. In particular, the upper pin 38 isaligned with the anvil slot 42 and the elongate channel 16 isaffirmatively engaged about the channel slot 45 by the middle pin 46 andthe firing bar cap 44.

With reference to FIGS. 38 and 39, after tissue clamping has occurred,the clinician moves the firing trigger 28 proximally causing the firingbar 14 to move distally into the end effector 12. In particular, themiddle pin 46 enters the staple cartridge 300 through the firing driveslot 47 to affect the firing of the staples 222 (not shown in FIGS. 38and 39) via wedge sled 400 toward the anvil 18. The lowermost pin, orfiring bar cap 44, cooperates with the middle pin 46 to slidinglyposition cutting edge 48 of the firing bar 14 to sever tissue. The twopins 44, 46 also position the upper pin 38 of the firing bar 14 withinlongitudinal anvil slot 42 of the anvil 18, affirmatively maintainingthe spacing between the anvil 18 and the elongate channel 16 throughoutits distal firing movement.

With reference to FIGS. 40 and 41, the clinician continues moving thefiring trigger 28 until brought proximal to the closure trigger 26 andpistol grip 24. Thereby, all of the ends of the staples 222 are bentover as a result of their engagement with the anvil 18. The firing barcap 44 is arrested against a firing bar stop 250 projecting toward thedistal end of the channel slot 45. The cutting edge 48 has traversedcompletely through the tissue. The process is complete by releasing thefiring trigger 28 and by then depressing the release button 30 whilesimultaneously squeezing the closure trigger 26 to open the end effector12.

FIGS. 42-43 show the inside and outside sled cams 410, 420 of the sled400 having different heights so that the staples, when formed, may havedifferent formed heights. In particular, as shown in FIG. 42 the outsidesled cam 420 may be shorter than the inside sled cam 410. That way, theoutside staples may have a greater formed height than the insidestaples. FIG. 42 is a perspective view of the sled 400 with thedifferent heights for the inside and outside sled cams 410, 420. FIG. 43is a side view of the end effector 12 showing various stages of drivingthe staples 222 with a sled 400 having different heights for the insideand outside sled cams 410, 420. As can be seen in FIG. 43, the formedstaple 222 b may have a greater formed height than the formed staple 222a because the staple 222 b was driven by the outside cam sled 420 andthe staple 222 a was driven by the taller inside cam sled 410.

In another embodiment, as shown in FIG. 44, the heights of the driverportions 342, 352 of a double driver 330 may vary so that the staples,when formed, may have different heights. In particular, as shown in FIG.44, the secondary driver portion 352 may be shorter (having height “E”)than the primary driver portion 342 (having height “D”). That way, thestaple 222 a driven by the secondary driver portion 352 may have agreater formed height than the staple 222 b driven by the primary driverportion 342. In various embodiments, some or all of the inside doubledrivers 330 could have primary and secondary driver portions 342 ofdifferent heights. Further, the heights differential need not be all thesame. Different inside double drivers 330 could have different heightdifferentials.

In addition, the height of the primary and secondary driver portions342, 352 may be the same as or different from the height of the driverportions 372 of the outside staple drivers 370. That is, in variousembodiments, the driver height of the outside staple driver portion 372may be (1) different from the height of both driver portions 342, 352 ofthe inside double driver 330 when the driver portions 342, 352 are thesame height, (2) different from the height of both driver portions 342,352 when they are different heights, or (3) the same as the height forone of the driver portions 342, 352 when the driver portions 342, 352have different heights. Also, the heights of the driver portions 372 ofthe outside staple drivers 370 need not be all the same. Differentoutside staple drivers 370 could have different heights.

FIG. 45 shows an embodiment having different height drivers (e.g., theprimary driver portion 342 taller than the secondary driver portion 352)and with different depth anvil pockets 202. Varying the depth of theanvil pockets 202 can also affect the height of the formed staples. Allthings being equal, deeper pockets should result in longer formedstaples. In the illustrated embodiment, the pockets 202 corresponding tothe primary driver portion 342 are deeper than the pockets 202corresponding to the secondary driver portion 352. Some or all of thepockets 202 for each staple row 500-510 could be deeper. Also, the depthdifferentials need not be the same. A multitude of different depthscould be used in a single row 500-510 or across rows 500-510.

In addition, as shown in FIG. 46, staples 222 with differingpre-formation prong heights (“P”) may be used. In the illustratedembodiment, the longer staple 222 a is used with the shorter, secondarydriver portion 352 of an inside double driver 330 in comparison withstaple 222 b driven by the primary driver portion 342. The pre-formationstaple prong lengths may vary within a staple row 500-510 or acrossstaple rows. That is, for example, all of the staples in the inside rows504-506 could have the same pre-formation prong length x, all of thestaples in the intermediate rows 502, 508 could be longer (e.g., alength 1.10×), and all of the staples in the outer rows 500, 510 couldbe still longer (e.g., a length of 1.20×). As shown in FIG. 47, theanvil pockets 202 could have the same depth. In other embodiments,varying anvil pocket depths could be used.

FIG. 48 is a side view of the end effector 12 in an embodiment where theoutside staple drivers 370 have different heights. In particular, in theillustrated embodiment, the first staple driver 370′ is taller than thesecond staple driver 370″. In the illustrated embodiment, the staples222 have the same pre-formation prong length and the corresponding anvilpockets 202 have the same depth. As such, the formed staple 222″ formedwith the second outside staple driver 370″ is longer than the formedstaple 222′ formed with the first outside staple driver 370′.

FIG. 49 is a side view of the end effector 12 where the anvil 18 haspockets 202 of different depth for the staples 222 driven by a insidedouble driver 330. In the illustrated embodiment, the pockets 202corresponding to the primary driver portion 342 are deeper than thecorresponding pockets 202 for the secondary driver portion 352. In thisembodiment, the primary and secondary driver portions 342, 352 are thesame height and the staples 222 have the same pre-formation pronglength. The distance between the top of the primary driver portion 342and the top of the corresponding anvil pockets 202 is height “A” and thecorresponding height for the secondary portion 352 is height “B,” where“A” is greater than “B” by a height differential “h”. This should resultin longer formed staples for the primary driver portion 342, as shown inFIG. 50.

FIGS. 51 and 60 show aspects of an end effector 12 according to otherembodiments that can be used to produce staples of different formedlengths. In the illustrated embodiment, the staple drivers 330, 370 aredriven in stages by a plurality of actuator wedge cams 709 at the distalend of a plurality of wedge band sets 710, 712, 714. In the illustratedembodiment, each wedge band set comprise four wedge bands (shown best inFIG. 56); two 720 for actuating the inner drivers 330 a,b and two 722for actuating the outer drivers 370 a,b. The wedge bands of the wedgeband sets 710, 712, 714 may be actuated in serial order and may ride ontop of one another in a stack to drive the staple drivers 330 a,b, 370a,b (and hence the staples 222) in serial stages. For example, the wedgebands of the lowermost actuator wedge band set 710 may be fired (oractuated) first, and may partially deploy the staples 222. The middlewedge band set 712, which rides on top of the lowermost wedge band set710 as shown in FIGS. 53-56, may be actuated next, which may have theeffect of beginning to form the staples 222. Then the uppermost wedgeband set 714, which rides on the middle wedge band set 712, may beactuated, which finishes the formation of the staples 222. FIG. 56illustrates this operation. In FIG. 56, the lowermost wedge band sets710 have been fired, the middle wedge band sets 712 have been partiallyfired, and the uppermost wedge band set 714 has not yet been fired.Thus, such an embodiment may comprise a plurality (in this case four) ofstacked wedge band sets, each stack comprising a wedge band from thelowermost set 710, the middle set 712, and the uppermost set 714.

The firing bar 716, with the e-beam firing mechanism 14, may then befired to cut the tissue clamped by the end effector 12. A hold downspring 718, which may be connected to the frame 34 at a crossbar 719,may engage and urge the firing bar 716 downward.

As can be seen best in FIGS. 54 and 56, the cumulative height of thewedge band stacks of inner row 720 or may be greater than the cumulativeheight of the wedge band stacks of the outer row 722 (by a heightdifferential h′). That way, the outer row of staples may have a greaterformed length than the inner row of formed staples, as shown in theexample of FIG. 55, where the outer row staple 222 a has a greaterformed length than the inner row staple 222 b. As shown the example ofFIG. 61, according to one embodiment, the wedge bands of the lowermostand middle wedge bands sets 710, 712 may be the same height, and theheight of the wedge bands for the outer row 722 of the uppermost wedgeband set 714 may be less than the height of the wedge bands of the innerrow 720 of the uppermost wedge band set 714 to provide the heightdifferential for the different wedge band stacks.

The end effector 12 in such an embodiment may still comprise a sled 400,but without the sled cams 410, 420, to keep the firing mechanism 14 outof the lockout in the channel (see FIGS. 3-4 and related text).

The inner and outer wedge band stacks 720, 722 may be tightly spacedwithin the frame 34. Accordingly, the end effector 12 may furthercomprise an actuator wedge band respective guide 702 for spreading outthe wedge band stacks 720, 722 when they enter the end effector 12 toalign with the staple drivers 330, 370. The wedge band guide 702 mayinclude wedge band channels for each of the inner and outer wedge bandstacks 720, 722. That is, in the illustrated embodiment, the wedge bandguide 702 may comprise four wedge band channels—two of the inner rows720 and two for the outer rows 722. FIGS. 58-60 show one side of thewedge band guide 702 in more detail. As shown in FIG. 60, the wedge bandchannels 730, 732 may force the wedge band stacks 720, 722 outward asthey enter the end effector 12. The inner wedge band channel 730 maydirect the inner wedge band stack 720 so that the inner wedge band stack720 aligns with the inner staple drivers 330 and the outer wedge bandchannel 732 may direct the outer row wedge band stack 722 so that theouter wedge band stack aligns with the outer staple drivers 370. In theillustrated embodiment, the channels 730, 732 are straight. In otherembodiments, one or both of the channels 730, 732 may comprise curvedportions.

FIG. 62 is a cross-sectional view of the shaft assembly 10 according tosuch an embodiment. As shown in FIG. 62, each wedge band set 710-714 mayhave its own actuation (or firing) bar. The lowermost actuation bar 740may actuate the wedge bands of the lowermost wedge band set 710, themiddle actuation bar 742 may actuate the wedge bands of the middle wedgeband set 712, and the uppermost actuation bar 744 may actuate the wedgebands of the uppermost wedge band set 714. The firing bar 716 foractuating the cutting instrument 14 may be connected to the uppermostwedge band set 714 so that the cutting instrument 14 is actuated withthe uppermost (last) wedge band set 714. In other embodiments, thefiring bar 716 may have its own actuation mechanism so that is may beactuated separately.

In practice, the clinician may choose (or select) to actuate less thanall of the wedge band sets 710-714 before actuating the firing rod 716to cut the tissue to thereby exercise some choice in the length of thestaples to be formed. For example, in various embodiments, the clinicianmay select to actuate the lowermost and middle wedge band sets 710,712—and not the uppermost wedge band set 714—before cutting.

FIGS. 63-69 illustrate an embodiment of an open linear stapling andcutting device 800 that may use multiple stacked wedge band sets toproduce staples of different formed lengths. In the illustratedembodiment, the anvil 810 is below the channel 809. As such, the staplesare driven down through tissue clamped in the end effector 12 as part ofthe stapling operation.

The device 800 may include an upper body piece 802 and a lower bodypiece 804. The upper body piece 802 may include a channel 806 in whichthe staple cartridge 809 is inserted. The anvil 810 may be connected tothe lower body piece 804 and face the staple cartridge 809 so that thestaples 222 can be formed against the staple forming surface 812 of theanvil 810. When the clinician is satisfied with the position of thetissue between the cartridge 809 and the anvil 810, the clinician maylock the device 800 using a clamp lever 814 of a clamp lever assembly816 connected to the upper body piece 802.

The staple drivers 820 in the cartridge 809 may be actuated in stagesusing multiple staged wedge band stacks. Because the staples 222 aredriven down in this embodiment, the wedge bands of the uppermost wedgeband set 822 may be actuated first to partially deploy the staples 222.Next, the wedge bands of the middle wedge band set 824, which ride onthe uppermost wedge band set 822, may be actuated to begin forming thestaples 222. Then the wedge bands of the lowermost wedge band set 826,which ride on the middle wedge band set 824, may be actuated, whichfinishes the formation of the staples 222.

In the illustrated embodiment, the firing bar 828, with the knife 830 atis distal end, is connected to the lowermost wedge band set 826 and isfired with the lowermost wedge band set 826. A hold down spring 832 mayengage and urge the firing bar 828 upward. A knife retainer 834 mayretain the firing bar 828 with the lowermost wedge band set 826.

As best shown in FIGS. 67-68, the clinician may actuate the wedge bandsets using a three-part actuation slide bar 840. The upper piece 842 mayactuate the uppermost (initial) wedge band set 822. The middle piece 844may actuate the middle wedge band set 824. The lower piece 846 mayactuate the lowermost (last) wedge band set 826.

To form staples of different formed heights, the staple pushers 820 mayhave different heights. For example, as shown in FIG. 66, one set ofstaple pusher 820 a could be shorter than another set of staple pushers820 b. As such, the formed staple 222 a, produced by the shorter staplepusher 820 a, may have a longer formed length than the formed staple 222b, formed by the longer staple pusher 820 b. In other embodiments, thestaples 222 may have different lengths or wire diameters to createdifferent length formed staples, and/or the pockets 202 in the anvil 810could have different depths to create different length formed staples.Also, the cumulative heights of the wedge band stacks could bedifferent.

According to various embodiments of the present invention, the stapledrivers could have a staple/driver interface that permits staples ofvarying wire diameter to be employed. For example, as shown in theembodiments of FIGS. 78-83, the outside staple drivers 370 a,b may havea raised dimple configuration on its upper surface for supportingstaples having differing wire diameters. The dimple configuration maycomprise, as shown in the illustrated embodiment, two inner sets ofoutwardly protruding dimples (or convex bumps) 620 a,b, and two outersets of dimples 622 a,b. Each set of dimples defines a receiving areawhere a staple 222 may sit in the upright position, as shown in FIGS.81-83. The dimples of the inner sets 620 a,b may be larger than thedimples of the outer dimple sets 622 a,b so that the receiving area ofthe inner sets 620 a,b is less than for the outer dimple sets 622 a,b.Nevertheless, due to the convex nature of the dimples, staples 222 ofvarying wire thicknesses may be accommodated, as shown in FIGS. 82 and83. For example, the dimples could be configured so that the stapledrivers 370 can accommodate staples having a wire diameter of 0.006inches to 0.012 inches, or some other range such as 0.004 inches to0.008 inches or 0.006 inches to 0.008 inches, etc. As such, staples ofdifferent wire thicknesses could be used in a single cartridge 306.Differing wire diameters would produce different formed staple heightsall other things being equal (e.g., same drive/crush distance, samepocket depth, etc.). In addition, as shown best in FIG. 78, the staplecradles for the inside drivers 330 may include sharp points 624 that mayinjure the tissue that is being stapled. The dimple configurations onthe outside staple drivers 370 lack such sharp points, which would tendto minimize the trauma on the tissue being stapled.

In the illustrated embodiment, the outer staple drivers 370 a,b have theraised dimple configuration in order to accommodate staples of differentwire diameters and the staple cradles of the inside staple drivers 342,352 can only support upright staples of one general wire diameter. Inother embodiments, the one or both of the inside staple drivers 342, 352may also or alternatively have the raised dimple configuration. Also,rather than using the raised dimple configuration, a v-shaped staplechannel 349, 379 may be used. Such a v-shaped channel may alsoaccommodate staples having different wire diameters. Also, staplepushers with staple interfaces that accommodate different staple wirediameters could be used with other types of staple drivers than theinside double and outside single staple drivers shown in FIGS. 78-83.

FIGS. 70-77 are cross-sectional frontal views of the end effector 12according to various embodiments of the present invention. In theembodiment shown in FIG. 70, the anvil 18 is stepped, having a centralportion 19 that is offset relative to (or not coplanar with) the twolateral side portions 21, 23. Also, the upper surface 306 of thecartridge 300 has a recessed central portion 307 and two lateral sideportions 309 (see FIG. 19A). All the staples 222 have the samepre-formation prong height and the corresponding anvil pockets 202 havethe same depth. However, due to the stepped nature of the anvil 18, thepockets 202 on the two lateral side portions 21, 23 of the anvil 18 areoffset from the pockets in the central portion 19 of the anvil.Offsetting the vertical position of the staple forming pockets 202 canaffect the length of the formed staples 222. All other things beingequal, staples formed by staple forming pockets that are elevated willhave a longer formed length than staples formed with pockets that arenot elevated. Also in this embodiment, the primary and secondary driverportions 342, 352 of the double inside drivers 330 a,b are the sameheight, and the height of the driver portion 372 of the outside stapledrivers 370 a,b is greater than the height of the driver portions 342,352 of the double inside staple drivers 330 a,b. Also, the inside andoutside sled cams 410, 4120 are the same height in this embodiment.

FIG. 71 shows an embodiment where the end effector 12 has a steppedcartridge tray 224 at the bottom of the cartridge 300 to match the stepsin the channel 16. In particular, in the illustrated embodiment, thecartridge tray 224 has a central portion 602 on which the double insidestaple drivers 330 a,b rest and outer lateral portions 604 on which theoutside staple drivers 370 a,b rest. As can be seen in FIG. 71, thecentral portion 602 of the cartridge tray 224 is elevated above thelateral portions 604. As such, the sled 400 may be configured so thatthe outside sled cam 420 is positioned lower than the inside sled cam410 so that the outside sled cam 420 can engage the lower outside driverportions 370 a,b.

The embodiment illustrated in FIG. 72 is similar to that shown in FIG.71 except that in FIG. 72 the cartridge 300 does not include thecartridge tray 224. Rather, the staple drivers 330, 370 rest directly onthe channel 16. Such an embodiment may be beneficial because it mayallow for more material (e.g., metal) in the channel 16 at points A andB than in a similar embodiment with the cartridge tray 224 (such asshown in FIG. 71).

The embodiment illustrated in FIG. 73 is also similar to that shown inFIG. 71 except that in FIG. 73 the cartridge tray 224 is raised slightlyrelative to the bottom on the channel 16 in comparison with theembodiment shown in FIG. 71. Such an embodiment may also allow for morematerial (e.g., metal) in the channel 16 at points A and B than in theembodiment shown in FIG. 71. According to other embodiments, the heightof the anvil 18 could be reduced to permit more material in the channel16 at points A and B.

The embodiment of FIG. 74 is similar to that used in FIG. 73 except thatno cartridge tray 224 is included in the embodiment of FIG. 74.

The embodiment of FIG. 75 is similar to that of FIG. 70 except than inFIG. 75 the outer rows of pockets 202 are formed in a compliant materialportion 610 of the anvil 18. The compliant material portion 610 may bemade from a material that is more compliant to the rest of the anvil 18.For example, the compliant material portion 610 may be made from plasticor a plastic composite material and the rest of the pockets may bedefined in a less-compliant material, such as stainless steel, of theanvil 18. The less-compliant anvil portion is sometimes referred toherein as “non-compliant” to distinguish it from the compliant materialsportion 610, although it should be recognized that the so-callednon-compliant material portion would be somewhat compliant, just lesscompliant than the compliant material portion 610. All things beingequal, staples formed with the outer pockets 202 formed in the compliantmaterial portion 610 of the anvil 18 would be longer than stapled formin the non-compliant (e.g., metal) portion of the anvil 18 because thecompliant material portion 610 would compress more during the stapleformation process.

FIGS. 76 and 77 collectively show another embodiment. In thisembodiment, the channel 16 includes a compliant material portion 612under the outside drivers 370. The complaint material portion 612 may beplastic or a composite plastic, for example. The inside drivers 330 mayrest on the less-compliant (or “non-compliant”) channel 16, which may bemade of metal (e.g., stainless steel). The outside sled cam 420 mayslightly compress the compliant material portions 612 under the outsidedrivers 370 when forming the staples in relation to the inside drivers330 on the channel 16, thereby forming slightly longer staples in theoutside rows. In other embodiments, the compliant material portions 612could be under the inside drivers 330 if it was desired to make theinside staples have a greater formed length.

According to other embodiments, staples of different materials could beused to produce staples of different formed lengths. The differentmaterials may have different modulus of elasticity so that they will beformed differently given the same driving force. Staples having a highermodulus of elasticity will tend to be deformed less given the samedriving force, thereby tending to produce staples having a longer formedlength. The different materials for the staples 222 may comprisetitanium, stainless steel, alloys, etc.

The present invention is also directed to other types of surgicalcutting devices that can create formed staples of different heights. Forexample, FIGS. 84-89 illustrate a circular stapler 900 that is capableof forming staples with different formed heights. As seen in FIG. 84,the circular stapler 900 includes a head 902, an anvil 904, anadjustment knob assembly 906, and a trigger 908. The head 902 is coupledto a handle assembly 910 by an arcuate shaft assembly 912. The trigger908 is pivotally supported by the handle assembly 910 and acts tooperate the stapler 900 when a safety mechanism (not shown) is released.When the trigger 908 is activated, a firing mechanism (not shown in FIG.84) operates within the shaft assembly 912 so that staples 914 areexpelled from the head 902 into forming contact with the anvil 904.Simultaneously, a knife 916 operably supported within the head 902 actsto cut tissue clamped between the head 902 and the anvil 904. Thestapler 900 is then pulled through the tissue leaving stapled tissue inits place.

FIGS. 85 and 86 illustrate one form of the anvil 904 and the head 902that may be employed in connection with various embodiments of thesubject invention. As can be seen in these figures, the anvil 904 mayhave a circular body portion 920 that has an anvil shaft 922 forattaching a trocar (not shown) thereto. The anvil body 920 has a stapleforming surface 924 thereon and may also have a shroud 926 attached tothe distal end thereof. The anvil 904 may be further provided with apair of trocar retaining clips or leaf-type springs 928 that serve toreleasably retain the trocar in retaining engagement with the anvilshaft 922. A plastic knife board 930 may be fitted into a cavity 932 inthe anvil body 904.

The head 902 may comprise a casing member 940 that supports a cartridgesupporting assembly in the form of a circular staple driver assembly 942therein that is adapted to interface with a circular staple cartridge944 and drive the staples 914 supported therein into forming contactwith the staple forming surface 924 of the anvil 904. The circular knifemember 916 is also centrally disposed within the staple driver assembly942. The proximal end of the casing member 940 may be coupled to anouter tubular shroud 946 of the arcuate shaft assembly 912 by a distalferrule member 948. More details regarding circular staples may be foundin U.S. patent application Ser. No. 11/541,151, entitled “SurgicalCutting and Stapling Device with Closure Apparatus for Limiting MaximumTissue Compression Force,” by F. Shelton et al., filed Sep. 29, 2006,which is incorporated herein by reference.

As can be seen in FIGS. 85-89, the staple driver assembly 942 maycomprise an outer ring of staple drivers 950 and an inner ring of stapledrivers 952. Correspondingly, the anvil 904 may comprise two concentricrings of staple forming pockets 202. Actuation of the firing trigger 908of the handle assembly 910 cause a compression shaft (not shown) of theshaft assembly 912 to move distally thereby driving the staple driverassembly 942 distally to fire the staples 914 into forming contact withthe staple forming surface 924 of the anvil 904. Thus, the outer stapledrivers 950, when actuated by the drive mechanism of the stapler 900,drive an outer ring of staples 914 into the clamped tissue and areformed by surface forming surface 924 of the anvil 904. Similarly, theinner staple drivers 952, when actuated by the drive mechanism of thestapler 900, drive an outer ring of staples 914 into the clamped tissueand are formed by surface forming surface 924 of the anvil 904.

The staple drivers 950, 952 could be of different heights to therebyform different length formed staples (all other things being equal). Forexample, as shown in the illustrated embodiment, the outer stapledrivers 950 may be shorter than the inner staple drivers 952 so that theouter formed staples are longer than the inner formed staples, as shownin FIG. 88. Of course, in other embodiments, the inner staple drivers952 could be shorter than the outer staple drivers 950. Further, theouter staple drivers 950 may not be a uniform height; there could beheight variation among the outer staple drivers 950. Similarly, therecould be height variation among the inner staple drivers 952.

In addition, staples with different pre-formation prong heights could beused. Also, the staple forming pockets 202 in the surface formingsurface 924 of the anvil 904 may have varying depths to thereby vary thelength of the formed staples. Also, as described above, some or all ofthe staple drivers 950, 952 may have a dimple configuration at theirinterface with the staples 914 to accommodate staples of different wirediameters or some other configuration that accommodates staples ofdifferent wire diameters (e.g., a v-shaped staple channel). Also, someof the pockets 202 in the anvil 1006 may be formed in a compliantmaterial portion of the anvil 1006. Also, the staples 914 could be madeof materials that have a different modulus of elasticity.

In other embodiments, as shown in FIGS. 90-95, the present invention isdirected to a linear stapler 1000 that is capable of forming staples ofdifferent heights. FIGS. 90-95 focus on the end effector 1002 for such alinear stapler 1000. The end effector 1002 may comprise a replaceablestaple cartridge 1004 and a linear anvil 1006. The cartridge 1004comprises staples which are driven into and formed by the anvil 1006when the device 1000 is actuated. Unlike the endocutters describedbefore, the anvil 1006 may be non-rotatable in the linear stapler 1000.To clamp tissue in the end effector 1002, the user may squeeze aclamping trigger (not shown), which causes the cartridge 1004 to slidedistally toward the anvil 1006 from an open position to a closedposition. More details regarding the operation and components of a linerstapler may be found in U.S. Pat. No. 5,697,543, entitled “LinearStapler With Improved Firing Stroke,” by M. Burdorff (“the '543patent”), which is incorporated herein by reference. Typically, suchlinear staplers do not comprise a cutting instrument.

FIGS. 92-93 show the end effector 1002 with the outer cover of thecartridge 1004 removed. As can be seen in these figures, the staplecartridge 1004 may comprise a staple driver assembly 1010 comprising arow of inner staple drivers 1012 and a row of outer staple drivers 1014.The staple drivers 1012, 1014 could be of different heights to therebyform different length formed staples (all other things being equal). Forexample, as shown in the illustrated embodiment, the outer stapledrivers 1014 may be shorter than the inner staple drivers 1012 so thatthe outer formed staples 222 b are longer than the inner formed staples222 a, as shown in FIGS. 94-95. Of course, in other embodiments, theinner staple drivers 1012 could be shorter than the outer staple drivers1014. Further, the outer staple drivers 1014 may not be a uniformheight; there could be height variation among the outer staple drivers1014. Similarly, there could be height variation among the inner stapledrivers 1012. Also, the cartridge 1004 may comprise, for example, threerows of staples, where the outer two rows have shorter staple driversand the inner row has longer staple drivers.

In addition, staples 1008 having different pre-formation prong heightscould be used. Also, the staple forming pockets 202 in the surfaceforming surface 1016 of the anvil 1006 may have varying depths tothereby vary the length of the formed staples. Also, as described above,some or all of the staple drivers 1012, 1014 may have a dimpleconfiguration at their interface with the staples 1008 to accommodatestaples of different wire diameters or some other configuration thataccommodates staples of different wire diameters (e.g., a v-shapedstaple channel). Also, some of the pockets 202 in the anvil 1006 may beformed in a compliant material portion of the anvil 1006. Also, staples1008 of different materials could be used.

In operation, as described in more detail in the '543 patent, when theclamping trigger is retracted by the user, the anvil 1006 is cause toslide proximally toward the staple cartridge 1004 into the closedposition to clamp tissue in the end effector 102. The cartridge 1004 maycomprise a distally-extending tissue retaining pin 1020 that engages anopening 1022 in the anvil when the end effector 1002 is in the closedposition to retain the tissue between the cartridge 1004 and the anvil1002. When the clinician retracts the separate firing trigger (notshown), a distally extending firing bar (not shown) is actuated, whichactuates the staple drivers 1010 to drive the staples 1008.

In another embodiment, the linear stapler 1000 could be configured sothat the staple cartridge 1004 slides distally toward the anvil when theclamping trigger is actuated.

It should be recognized that stapling devices according to the presentinvention may combine some of the features described herein for creatingstaples of different formed lengths. For example, for embodiments havingdifferent staple crushing distances, the staples may all have the samepre-formation prong length or some staples may have differentpre-formation prong lengths. Also, the staples may all be made out ofthe same material, or staples made of different materials, withdifferent modulus of elasticity, could be used. Also, the staple wirediameters may all be the same or some of them could be different.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Preferably, the various embodiments of the invention described hereinwill be processed before surgery. First, a new or used instrument isobtained and if necessary cleaned. The instrument can then besterilized. In one sterilization technique, the instrument is placed ina closed and sealed container, such as a plastic or TYVEK bag. Thecontainer and instrument are then placed in a field of radiation thatcan penetrate the container, such as gamma radiation, x-rays, orhigh-energy electrons. The radiation kills bacteria on the instrumentand in the container. The sterilized instrument can then be stored inthe sterile container. The sealed container keeps the instrument sterileuntil it is opened in the medical facility.

It is preferred that the device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam.

While the present invention has been illustrated by description ofseveral embodiments and while the illustrative embodiments have beendescribed in considerable detail, it is not the intention of theapplicant to restrict or in any way limit the scope of the appendedclaims to such detail. Additional advantages and modifications mayreadily appear to those skilled in the art. The various embodiments ofthe present invention represent vast improvements over prior staplemethods that require the use of different sizes of staples in a singlecartridge to achieve staples that have differing formed (final) heights.

Accordingly, the present invention has been discussed in terms ofendoscopic procedures and apparatus. However, use herein of terms suchas “endoscopic” should not be construed to limit the present inventionto a surgical stapling and severing instrument for use only inconjunction with an endoscopic tube (i.e., trocar). On the contrary, itis believed that the present invention may find use in any procedurewhere access is limited to a small incision, including but not limitedto laparoscopic procedures, as well as open procedures. Moreover, theunique and novel aspects of the various staple cartridge embodiments ofthe present invention may find utility when used in connection withother forms of stapling apparatuses without departing from the spiritand scope of the present invention.

Over the years a variety of minimally invasive robotic (or“telesurgical”) systems have been developed to increase surgicaldexterity as well as to permit a surgeon to operate on a patient in anintuitive manner. Many of such systems are disclosed in the followingU.S. patents which are each herein incorporated by reference in theirrespective entirety: U.S. Pat. No. 5,792,135, entitled “ArticulatedSurgical Instrument For Performing Minimally Invasive Surgery WithEnhanced Dexterity and Sensitivity”, U.S. Pat. No. 6,231,565, entitled“Robotic Arm DLUS For Performing Surgical Tasks”, U.S. Pat. No.6,783,524, entitled “Robotic Surgical Tool With Ultrasound Cauterizingand Cutting Instrument”, U.S. Pat. No. 6,364,888, entitled “Alignment ofMaster and Slave In a Minimally Invasive Surgical Apparatus”, U.S. Pat.No. 7,524,320, entitled “Mechanical Actuator Interface System ForRobotic Surgical Tools”, U.S. Pat. No. 7,691,098, entitled Platform LinkWrist Mechanism”, U.S. Pat. No. 7,806,891, entitled “Repositioning andReorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery”, and U.S. Pat. No. 7,824,401, entitled “Surgical Tool WithWrited Monopolar Electrosurgical End Effectors”. Many of such systems,however, have in the past been unable to generate the magnitude offorces required to effectively cut and fasten tissue.

FIG. 96 depicts one version of a master controller 11001 that may beused in connection with a robotic arm slave cart 11100 of the typedepicted in FIG. 96. Master controller 11001 and robotic arm slave cart11100, as well as their respective components and control systems arecollectively referred to herein as a robotic system 11000. Examples ofsuch systems and devices are disclosed in U.S. Pat. No. 7,524,320 whichhas been herein incorporated by reference. Thus, various details of suchdevices will not be described in detail herein beyond that which may benecessary to understand various embodiments and forms of the presentinvention. As is known, the master controller 11001 generally includesmaster controllers (generally represented as 11003 in FIG. 96) which aregrasped by the surgeon and manipulated in space while the surgeon viewsthe procedure via a stereo display 11002. The master controllers 11001generally comprise manual input devices which preferably move withmultiple degrees of freedom, and which often further have an actuatablehandle for actuating tools (for example, for closing grasping saws,applying an electrical potential to an electrode, or the like).

As can be seen in FIG. 97, in one form, the robotic arm cart 11100 isconfigured to actuate a plurality of surgical tools, generallydesignated as 11200. Various robotic surgery systems and methodsemploying master controller and robotic arm cart arrangements aredisclosed in U.S. Pat. No. 6,132,368, entitled “Multi-ComponentTelepresence System and Method”, the full disclosure of which isincorporated herein by reference. In various forms, the robotic arm cart11100 includes a base 11002 from which, in the illustrated embodiment,three surgical tools 11200 are supported. In various forms, the surgicaltools 11200 are each supported by a series of manually articulatablelinkages, generally referred to as set-up joints 11104, and a roboticmanipulator 11106. These structures are herein illustrated withprotective covers extending over much of the robotic linkage. Theseprotective covers may be optional, and may be limited in size orentirely eliminated in some embodiments to minimize the inertia that isencountered by the servo mechanisms used to manipulate such devices, tolimit the volume of moving components so as to avoid collisions, and tolimit the overall weight of the cart 11100. Cart 11100 will generallyhave dimensions suitable for transporting the cart 11100 betweenoperating rooms. The cart 11100 may be configured to typically fitthrough standard operating room doors and onto standard hospitalelevators. In various forms, the cart 11100 would preferably have aweight and include a wheel (or other transportation) system that allowsthe cart 1100 to be positioned adjacent an operating table by a singleattendant.

Referring now to FIG. 98, in at least one form, robotic manipulators11106 may include a linkage 11108 that constrains movement of thesurgical tool 11200. In various embodiments, linkage 11108 includesrigid links coupled together by rotational joints in a parallelogramarrangement so that the surgical tool 11200 rotates around a point inspace 11110, as more fully described in issued U.S. Pat. No. 5,817,084,the full disclosure of which is herein incorporated by reference. Theparallelogram arrangement constrains rotation to pivoting about an axis11112 a, sometimes called the pitch axis. The links supporting theparallelogram linkage are pivotally mounted to set-up joints 11104 (FIG.97) so that the surgical tool 11200 further rotates about an axis 11112b, sometimes called the yaw axis. The pitch and yaw axes 11112 a, 11112b intersect at the remote center 11114, which is aligned along a shaft11208 of the surgical tool 11200. The surgical tool 11200 may havefurther degrees of driven freedom as supported by manipulator 11106,including sliding motion of the surgical tool 11200 along thelongitudinal tool axis “LT-LT”. As the surgical tool 11200 slides alongthe tool axis LT-LT relative to manipulator 11106 (arrow 11112 c),remote center 11114 remains fixed relative to base 11116 of manipulator11106. Hence, the entire manipulator is generally moved to re-positionremote center 11114. Linkage 11108 of manipulator 11106 is driven by aseries of motors 11120. These motors actively move linkage 11108 inresponse to commands from a processor of a control system. As will bediscussed in further detail below, motors 11120 are also employed tomanipulate the surgical tool 11200.

An alternative set-up joint structure is illustrated in FIG. 99. In thisembodiment, a surgical tool 11200 is supported by an alternativemanipulator structure 11106′ between two tissue manipulation tools.Those of ordinary skill in the art will appreciate that variousembodiments of the present invention may incorporate a wide variety ofalternative robotic structures, including those described in U.S. Pat.No. 5,878,193, entitled “Automated Endoscope System For OptimalPositioning”, the full disclosure of which is incorporated herein byreference. Additionally, while the data communication between a roboticcomponent and the processor of the robotic surgical system is primarilydescribed herein with reference to communication between the surgicaltool 11200 and the master controller 11001, it should be understood thatsimilar communication may take place between circuitry of a manipulator,a set-up joint, an endoscope or other image capture device, or the like,and the processor of the robotic surgical system for componentcompatibility verification, component-type identification, componentcalibration (such as off-set or the like) communication, confirmation ofcoupling of the component to the robotic surgical system, or the like.

An exemplary non-limiting surgical tool 11200 that is well-adapted foruse with a robotic system 11000 that has a tool drive assembly 11010(FIG. 101) that is operatively coupled to a master controller 11001 thatis operable by inputs from an operator (i.e., a surgeon) is depicted inFIG. 100. As can be seen in that Figure, the surgical tool 11200includes a surgical end effector 12012 that comprises an endocutter. Inat least one form, the surgical tool 11200 generally includes anelongated shaft assembly 12008 that has a proximal closure tube 12040and a distal closure tube 12042 that are coupled together by anarticulation joint 12011. The surgical tool 11200 is operably coupled tothe manipulator by a tool mounting portion, generally designated as11300. The surgical tool 11200 further includes an interface 11230 whichmechanically and electrically couples the tool mounting portion 11300 tothe manipulator. One form of interface 11230 is illustrated in FIGS.101-105. In various embodiments, the tool mounting portion 11300includes a tool mounting plate 11302 that operably supports a pluralityof (four are shown in FIG. 105) rotatable body portions, driven discs orelements 11304, that each include a pair of pins 11306 that extend froma surface of the driven element 11304. One pin 11306 is closer to anaxis of rotation of each driven elements 11304 than the other pin 11306on the same driven element 11304, which helps to ensure positive angularalignment of the driven element 11304. Interface 11230 includes anadaptor portion 11240 that is configured to mountingly engage themounting plate 11302 as will be further discussed below. The adaptorportion 11240 may include an array of electrical connecting pins 11242(FIG. 103) which may be coupled to a memory structure by a circuit boardwithin the tool mounting portion 11300. While interface 11230 isdescribed herein with reference to mechanical, electrical, and magneticcoupling elements, it should be understood that a wide variety oftelemetry modalities might be used, including infrared, inductivecoupling, or the like.

As can be seen in FIGS. 101-104, the adapter portion 11240 generallyincludes a tool side 11244 and a holder side 11246. In various forms, aplurality of rotatable bodies 11250 are mounted to a floating plate11248 which has a limited range of movement relative to the surroundingadaptor structure normal to the major surfaces of the adaptor 11240.Axial movement of the floating plate 11248 helps decouple the rotatablebodies 11250 from the tool mounting portion 11300 when the levers 11303along the sides of the tool mounting portion housing 11301 are actuated(See FIG. 100). Other mechanisms/arrangements may be employed forreleasably coupling the tool mounting portion 11300 to the adaptor11240. In at least one form, rotatable bodies 11250 are resilientlymounted to floating plate 11248 by resilient radial members which extendinto a circumferential indentation about the rotatable bodies 11250. Therotatable bodies 11250 can move axially relative to plate 11248 bydeflection of these resilient structures. When disposed in a first axialposition (toward tool side 11244) the rotatable bodies 11250 are free torotate without angular limitation. However, as the rotatable bodies11250 move axially toward tool side 11244, tabs 11252 (extendingradially from the rotatable bodies 11250) laterally engage detents onthe floating plates so as to limit angular rotation of the rotatablebodies 11250 about their axes. This limited rotation can be used to helpdrivingly engage the rotatable bodies 11250 with drive pins 11272 of acorresponding tool holder portion 11270 of the robotic system 11000, asthe drive pins 11272 will push the rotatable bodies 11250 into thelimited rotation position until the pins 11234 are aligned with (andslide into) openings 11256′. Openings 11256 on the tool side 11244 andopenings 11256′ on the holder side 11246 of rotatable bodies 11250 areconfigured to accurately align the driven elements 11304 (FIG. 105) ofthe tool mounting portion 11300 with the drive elements 11271 of thetool holder 11270. As described above regarding inner and outer pins11306 of driven elements 11304, the openings 11256, 11256′ are atdiffering distances from the axis of rotation on their respectiverotatable bodies 11250 so as to ensure that the alignment is not 180degrees from its intended position. Additionally, each of the openings11256 is slightly radially elongated so as to fittingly receive the pins11306 in the circumferential orientation. This allows the pins 11306 toslide radially within the openings 11256, 11256′ and accommodate someaxial misalignment between the tool 11200 and tool holder 11270, whileminimizing any angular misalignment and backlash between the drive anddriven elements. Openings 11256 on the tool side 11244 are offset byabout 90 degrees from the openings 11256′ (shown in broken lines) on theholder side 11246, as can be seen most clearly in FIG. 104.

Various embodiments may further include an array of electrical connectorpins 11242 located on holder side 11246 of adaptor 11240, and the toolside 11244 of the adaptor 11240 may include slots 11258 (FIG. 104) forreceiving a pin array (not shown) from the tool mounting portion 11300.In addition to transmitting electrical signals between the surgical tool11200 and the tool holder 11270, at least some of these electricalconnections may be coupled to an adaptor memory device 11260 (FIG. 103)by a circuit board of the adaptor 11240.

A detachable latch arrangement 11239 may be employed to releasably affixthe adaptor 11240 to the tool holder 11270. As used herein, the term“tool drive assembly” when used in the context of the robotic system11000, at least encompasses various embodiments of the adapter 11240 andtool holder 11270 and which has been generally designated as 11010 inFIG. 101. For example, as can be seen in FIG. 101, the tool holder 11270may include a first latch pin arrangement 11274 that is sized to bereceived in corresponding clevis slots 11241 provided in the adaptor11240. In addition, the tool holder 11270 may further have second latchpins 11276 that are sized to be retained in corresponding latch devises11243 in the adaptor 11240. See FIG. 103. In at least one form, a latchassembly 11245 is movably supported on the adapter 1240 and is biasablebetween a first latched position wherein the latch pins 11276 areretained within their respective latch clevis 11243 and an unlatchedposition wherein the second latch pins 11276 may be into or removed fromthe latch devises 11243. A spring or springs (not shown) are employed tobias the latch assembly into the latched position. A lip on the toolside 11244 of adaptor 11240 may slidably receive laterally extendingtabs of tool mounting housing 11301.

Turning next to FIGS. 105-112, in at least one embodiment, the surgicaltool 11200 includes a surgical end effector 12012 that comprises in thisexample, among other things, at least one component 12024 that isselectively movable between first and second positions relative to atleast one other component 12022 in response to various control motionsapplied thereto as will be discussed in further detail below. In variousembodiments, component 12022 comprises an elongated channel 12022configured to operably support a surgical staple cartridge 12034 thereinand component 12024 comprises a pivotally translatable clamping member,such as an anvil 12024. Various embodiments of the surgical end effector12012 are configured to maintain the anvil 12024 and elongated channel12022 at a spacing that assures effective stapling and severing oftissue clamped in the surgical end effector 12012. As can be seen inFIG. 111, the surgical end effector 12012 further includes a cuttinginstrument 12032 and a sled 12033. The cutting instrument 12032 may be,for example, a knife. The surgical staple cartridge 12034 operablyhouses a plurality of surgical staples (not show) therein that aresupported on movable staple drivers (not shown). As the cuttinginstrument 12032 is driven distally through a centrally-disposed slot(not shown) in the surgical staple cartridge 12034, it forces the sled12033 distally as well. As the sled 12033 is driven distally, its“wedge-shaped” configuration contacts the movable staple drivers anddrives them vertically toward the closed anvil 12024. The surgicalstaples are formed as they are driven into the forming surface locatedon the underside of the anvil 12024. The sled 12033 may be part of thesurgical staple cartridge 12034, such that when the cutting instrument12032 is retracted following the cutting operation, the sled 12033 doesnot retract. The anvil 12024 may be pivotably opened and closed at apivot point 12025 located at the proximal end of the elongated channel12022. The anvil 12024 may also include a tab 12027 at its proximal endthat interacts with a component of the mechanical closure system(described further below) to facilitate the opening of the anvil 12024.The elongated channel 12022 and the anvil 12024 may be made of anelectrically conductive material (such as metal) so that they may serveas part of an antenna that communicates with sensor(s) in the endeffector, as described above. The surgical staple cartridge 12034 couldbe made of a nonconductive material (such as plastic) and the sensor maybe connected to or disposed in the surgical staple cartridge 12034, aswas also described above.

As can be seen in FIGS. 105-112, the surgical end effector 12012 isattached to the tool mounting portion 11300 by an elongated shaftassembly 12008 according to various embodiments. As shown in theillustrated embodiment, the shaft assembly 12008 includes anarticulation joint generally indicated as 12011 that enables thesurgical end effector 12012 to be selectively articulated about anarticulation axis AA-AA that is substantially transverse to alongitudinal tool axis LT-LT. See FIG. 106. In other embodiments, thearticulation joint is omitted. In various embodiments, the shaftassembly 12008 may include a closure tube assembly 12009 that comprisesa proximal closure tube 12040 and a distal closure tube 12042 that arepivotably linked by a pivot links 12044 and operably supported on aspine assembly generally depicted as 12049. In the illustratedembodiment, the spine assembly 12049 comprises a distal spine portion12050 that is attached to the elongated channel 12022 and is pivotallycoupled to the proximal spine portion 12052. The closure tube assembly12009 is configured to axially slide on the spine assembly 12049 inresponse to actuation motions applied thereto. The distal closure tube12042 includes an opening 12045 into which the tab 12027 on the anvil12024 is inserted in order to facilitate opening of the anvil 12024 asthe distal closure tube 12042 is moved axially in the proximal direction“PD”. The closure tubes 12040, 12042 may be made of electricallyconductive material (such as metal) so that they may serve as part ofthe antenna, as described above. Components of the main drive shaftassembly (e.g., the drive shafts 12048, 12050) may be made of anonconductive material (such as plastic).

In use, it may be desirable to rotate the surgical end effector 12012about the longitudinal tool axis LT-LT. In at least one embodiment, thetool mounting portion 11300 includes a rotational transmission assembly12069 that is configured to receive a corresponding rotary output motionfrom the tool drive assembly 11010 of the robotic system 11000 andconvert that rotary output motion to a rotary control motion forrotating the elongated shaft assembly 12008 (and surgical end effector12012) about the longitudinal tool axis LT-LT. In various embodiments,for example, the proximal end 12060 of the proximal closure tube 12040is rotatably supported on the tool mounting plate 11302 of the toolmounting portion 11300 by a forward support cradle 11309 and a closuresled 12100 that is also movably supported on the tool mounting plate11302. In at least one form, the rotational transmission assembly 12069includes a tube gear segment 12062 that is formed on (or attached to)the proximal end 12060 of the proximal closure tube 12040 for operableengagement by a rotational gear assembly 12070 that is operablysupported on the tool mounting plate 11302. As can be seen in FIG. 108,the rotational gear assembly 12070, in at least one embodiment,comprises a rotation drive gear 12072 that is coupled to a correspondingfirst one of the driven discs or elements 11304 on the adapter side11307 of the tool mounting plate 11302 when the tool mounting portion11300 is coupled to the tool drive assembly 11010. See FIG. 105. Therotational gear assembly 12070 further comprises a rotary driven gear12074 that is rotatably supported on the tool mounting plate 11302 inmeshing engagement with the tube gear segment 12062 and the rotationdrive gear 12072. Application of a first rotary output motion from thetool drive assembly 11010 of the robotic system 11000 to thecorresponding driven element 11304 will thereby cause rotation of therotation drive gear 12072. Rotation of the rotation drive gear 12072ultimately results in the rotation of the elongated shaft assembly 12008(and the surgical end effector 12012) about the longitudinal tool axisLT-LT (represented by arrow “R” in FIG. 108). It will be appreciatedthat the application of a rotary output motion from the tool driveassembly 11010 in one direction will result in the rotation of theelongated shaft assembly 12008 and surgical end effector 12012 about thelongitudinal tool axis LT-LT in a first direction and an application ofthe rotary output motion in an opposite direction will result in therotation of the elongated shaft assembly 12008 and surgical end effector12012 in a second direction that is opposite to the first direction.

In at least one embodiment, the closure of the anvil 12024 relative tothe staple cartridge 12034 is accomplished by axially moving the closuretube assembly 12009 in the distal direction “DD” on the spine assembly12049. As indicated above, in various embodiments, the proximal end12060 of the proximal closure tube 12040 is supported by the closuresled 12100 which comprises a portion of a closure transmission,generally depicted as 12099. In at least one form, the closure sled12100 is configured to support the closure tube 12009 on the toolmounting plate 11320 such that the proximal closure tube 12040 canrotate relative to the closure sled 12100, yet travel axially with theclosure sled 12100. In particular, as can be seen in FIG. 113, theclosure sled 12100 has an upstanding tab 12101 that extends into aradial groove 12063 in the proximal end portion of the proximal closuretube 12040. In addition, as can be seen in FIGS. 110 and 113, theclosure sled 12100 has a tab portion 12102 that extends through a slot11305 in the tool mounting plate 11302. The tab portion 12102 isconfigured to retain the closure sled 12100 in sliding engagement withthe tool mounting plate 11302. In various embodiments, the closure sled12100 has an upstanding portion 12104 that has a closure rack gear 12106formed thereon. The closure rack gear 12106 is configured for drivingengagement with a closure gear assembly 12110. See FIG. 110.

In various forms, the closure gear assembly 12110 includes a closurespur gear 12112 that is coupled to a corresponding second one of thedriven discs or elements 11304 on the adapter side 11307 of the toolmounting plate 11302. See FIG. 105. Thus, application of a second rotaryoutput motion from the tool drive assembly 11010 of the robotic system11000 to the corresponding second driven element 11304 will causerotation of the closure spur gear 12112 when the tool mounting portion11300 is coupled to the tool drive assembly 11010. The closure gearassembly 12110 further includes a closure reduction gear set 12114 thatis supported in meshing engagement with the closure spur gear 12112. Ascan be seen in FIGS. 109 and 110, the closure reduction gear set 12114includes a driven gear 12116 that is rotatably supported in meshingengagement with the closure spur gear 12112. The closure reduction gearset 12114 further includes a first closure drive gear 12118 that is inmeshing engagement with a second closure drive gear 12120 that isrotatably supported on the tool mounting plate 11302 in meshingengagement with the closure rack gear 12106. Thus, application of asecond rotary output motion from the tool drive assembly 11010 of therobotic system 11000 to the corresponding second driven element 11304will cause rotation of the closure spur gear 12112 and the closuretransmission 12110 and ultimately drive the closure sled 12100 andclosure tube assembly 12009 axially. The axial direction in which theclosure tube assembly 12009 moves ultimately depends upon the directionin which the second driven element 11304 is rotated. For example, inresponse to one rotary output motion received from the tool driveassembly 11010 of the robotic system 11000, the closure sled 12100 willbe driven in the distal direction “DD” and ultimately drive the closuretube assembly 11009 in the distal direction. As the distal closure tube12042 is driven distally, the end of the closure tube segment 12042 willengage a portion of the anvil 12024 and cause the anvil 12024 to pivotto a closed position. Upon application of an “opening” out put motionfrom the tool drive assembly 11010 of the robotic system 11000, theclosure sled 12100 and shaft assembly 12008 will be driven in theproximal direction “PD”. As the distal closure tube 12042 is driven inthe proximal direction, the opening 12045 therein interacts with the tab12027 on the anvil 12024 to facilitate the opening thereof. In variousembodiments, a spring (not shown) may be employed to bias the anvil tothe open position when the distal closure tube 12042 has been moved toits starting position. In various embodiments, the various gears of theclosure gear assembly 12110 are sized to generate the necessary closureforces needed to satisfactorily close the anvil 12024 onto the tissue tobe cut and stapled by the surgical end effector 12012. For example, thegears of the closure transmission 12110 may be sized to generateapproximately 70-120 pounds.

In various embodiments, the cutting instrument 12032 is driven throughthe surgical end effector 12012 by a knife bar 12200. See FIGS. 111 and113. In at least one form, the knife bar 12200 may be fabricated from,for example, stainless steel or other similar material and has asubstantially rectangular cross-sectional shape. Such knife barconfiguration is sufficiently rigid to push the cutting instrument 12032through tissue clamped in the surgical end effector 12012, while stillbeing flexible enough to enable the surgical end effector 12012 toarticulate relative to the proximal closure tube 12040 and the proximalspine portion 12052 about the articulation axis AA-AA as will bediscussed in further detail below. As can be seen in FIGS. 114 and 115,the proximal spine portion 12052 has a rectangular-shaped passage 12054extending therethrough to provide support to the knife bar 12200 as itis axially pushed therethrough. The proximal spine portion 12052 has aproximal end 12056 that is rotatably mounted to a spine mounting bracket12057 attached to the tool mounting plate 11032. See FIG. 113. Sucharrangement permits the proximal spine portion 12052 to rotate, but notmove axially, within the proximal closure tube 12040.

As shown in FIG. 111, the distal end 12202 of the knife bar 12200 isattached to the cutting instrument 12032. The proximal end 12204 of theknife bar 12200 is rotatably affixed to a knife rack gear 12206 suchthat the knife bar 12200 is free to rotate relative to the knife rackgear 12206. See FIG. 113. As can be seen in FIGS. 107-112, the kniferack gear 12206 is slidably supported within a rack housing 12210 thatis attached to the tool mounting plate 11302 such that the knife rackgear 12206 is retained in meshing engagement with a knife gear assembly12220. More specifically and with reference to FIG. 110, in at least oneembodiment, the knife gear assembly 12220 includes a knife spur gear12222 that is coupled to a corresponding third one of the driven discsor elements 11304 on the adapter side 11307 of the tool mounting plate11302. See FIG. 105. Thus, application of another rotary output motionfrom the robotic system 11000 through the tool drive assembly 11010 tothe corresponding third driven element 11304 will cause rotation of theknife spur gear 12222. The knife gear assembly 12220 further includes aknife gear reduction set 12224 that includes a first knife driven gear12226 and a second knife drive gear 12228. The knife gear reduction set12224 is rotatably mounted to the tool mounting plate 11302 such thatthe firs knife driven gear 12226 is in meshing engagement with the knifespur gear 12222. Likewise, the second knife drive gear 12228 is inmeshing engagement with a third knife drive gear 12230 that is rotatablysupported on the tool mounting plate 11302 in meshing engagement withthe knife rack gear 12206. In various embodiments, the gears of theknife gear assembly 12220 are sized to generate the forces needed todrive the cutting element 12032 through the tissue clamped in thesurgical end effector 12012 and actuate the staples therein. Forexample, the gears of the knife drive assembly 12230 may be sized togenerate approximately 40 to 100 pounds. It will be appreciated that theapplication of a rotary output motion from the tool drive assembly 11010in one direction will result in the axial movement of the cuttinginstrument 12032 in a distal direction and application of the rotaryoutput motion in an opposite direction will result in the axial travelof the cutting instrument 12032 in a proximal direction.

In various embodiments, the surgical tool 11200 employs and articulationsystem 12007 that includes an articulation joint 12011 that enables thesurgical end effector 12012 to be articulated about an articulation axisAA-AA that is substantially transverse to the longitudinal tool axisLT-LT. In at least one embodiment, the surgical tool 11200 includesfirst and second articulation bars 12250 a, 12250 b that are slidablysupported within corresponding passages 12053 provided through theproximal spine portion 12052. See FIGS. 113 and 115. In at least oneform, the first and second articulation bars 12250 a, 12250 b areactuated by an articulation transmission generally designated as 12249that is operably supported on the tool mounting plate 11032. Each of thearticulation bars 12250 a, 12250 b has a proximal end 12252 that has aguide rod protruding therefrom which extend laterally through acorresponding slot in the proximal end portion of the proximal spineportion 12052 and into a corresponding arcuate slot in an articulationnut 12260 which comprises a portion of the articulation transmission.FIG. 114 illustrates articulation bar 12250 a. It will be understoodthat articulation bar 12250 b is similarly constructed. As can be seenin FIG. 114, for example, the articulation bar 12250 a has a guide rod12254 which extends laterally through a corresponding slot 12058 in theproximal end portion 12056 of the distal spine portion 12050 and into acorresponding arcuate slot 12262 in the articulation nut 12260. Inaddition, the articulation bar 12250 a has a distal end 12251 a that ispivotally coupled to the distal spine portion 12050 by, for example, apin 12253 a and articulation bar 12250 b has a distal end 12251 b thatis pivotally coupled to the distal spine portion 12050 by, for example,a pin 12253 b. In particular, the articulation bar 12250 a is laterallyoffset in a first lateral direction from the longitudinal tool axisLT-LT and the articulation bar 12250 b is laterally offset in a secondlateral direction from the longitudinal tool axis LT-LT. Thus, axialmovement of the articulation bars 12250 a and 12250 b in opposingdirections will result in the articulation of the distal spine portion12050 as well as the surgical end effector 12012 attached thereto aboutthe articulation axis AA-AA as will be discussed in further detailbelow.

Articulation of the surgical end effector 12012 is controlled byrotating the articulation nut 12260 about the longitudinal tool axisLT-LT. The articulation nut 12260 is rotatably journaled on the proximalend portion 12056 of the distal spine portion 12050 and is rotatablydriven thereon by an articulation gear assembly 12270. More specificallyand with reference to FIG. 108, in at least one embodiment, thearticulation gear assembly 12270 includes an articulation spur gear12272 that is coupled to a corresponding fourth one of the driven discsor elements 11304 on the adapter side 11307 of the tool mounting plate11302. See FIG. 105. Thus, application of another rotary input motionfrom the robotic system 11000 through the tool drive assembly 11010 tothe corresponding fourth driven element 11304 will cause rotation of thearticulation spur gear 12272 when the interface 11230 is coupled to thetool holder 11270. An articulation drive gear 12274 is rotatablysupported on the tool mounting plate 11302 in meshing engagement withthe articulation spur gear 12272 and a gear portion 12264 of thearticulation nut 12260 as shown. As can be seen in FIGS. 113 and 114,the articulation nut 12260 has a shoulder 12266 formed thereon thatdefines an annular groove 12267 for receiving retaining posts 12268therein. Retaining posts 12268 are attached to the tool mounting plate11302 and serve to prevent the articulation nut 12260 from movingaxially on the proximal spine portion 12052 while maintaining theability to be rotated relative thereto. Thus, rotation of thearticulation nut 12260 in a first direction, will result in the axialmovement of the articulation bar 12250 a in a distal direction “DD” andthe axial movement of the articulation bar 12250 b in a proximaldirection “PD” because of the interaction of the guide rods 12254 withthe spiral slots 12262 in the articulation gear 12260. Similarly,rotation of the articulation nut 12260 in a second direction that isopposite to the first direction will result in the axial movement of thearticulation bar 12250 a in the proximal direction “PD” as well as causearticulation bar 12250 b to axially move in the distal direction “DD”.Thus, the surgical end effector 12012 may be selectively articulatedabout articulation axis “AA-AA” in a first direction “FD” bysimultaneously moving the articulation bar 12250 a in the distaldirection “DD” and the articulation bar 12250 b in the proximaldirection “PD”. Likewise, the surgical end effector 12012 may beselectively articulated about the articulation axis “AA-AA” in a seconddirection “SD” by simultaneously moving the articulation bar 12250 a inthe proximal direction “PD” and the articulation bar 12250 b in thedistal direction “DD.” See FIG. 106.

The tool embodiment described above employs an interface arrangementthat is particularly well-suited for mounting the roboticallycontrollable medical tool onto at least one form of robotic armarrangement that generates at least four different rotary controlmotions. Those of ordinary skill in the art will appreciate that suchrotary output motions may be selectively controlled through theprogrammable control systems employed by the robotic system/controller.For example, the tool arrangement described above may be well-suited foruse with those robotic systems manufactured by Intuitive Surgical, Inc.of Sunnyvale, Calif., U.S.A., many of which may be described in detailin various patents incorporated herein by reference. The unique andnovel aspects of various embodiments of the present invention serve toutilize the rotary output motions supplied by the robotic system togenerate specific control motions having sufficient magnitudes thatenable end effectors to cut and staple tissue. Thus, the uniquearrangements and principles of various embodiments of the presentinvention may enable a variety of different forms of the tool systemsdisclosed and claimed herein to be effectively employed in connectionwith other types and forms of robotic systems that supply programmedrotary or other output motions. In addition, as will become furtherapparent as the present Detailed Description proceeds, various endeffector embodiments of the present invention that require other formsof actuation motions may also be effectively actuated utilizing one ormore of the control motions generated by the robotic system.

FIGS. 117-121 illustrate yet another surgical tool 12300 that may beeffectively employed in connection with the robotic system 11000 thathas a tool drive assembly that is operably coupled to a controller ofthe robotic system that is operable by inputs from an operator and whichis configured to provide at least one rotary output motion to at leastone rotatable body portion supported on the tool drive assembly. Invarious forms, the surgical tool 12300 includes a surgical end effector12312 that includes an elongated channel 12322 and a pivotallytranslatable clamping member, such as an anvil 12324, which aremaintained at a spacing that assures effective stapling and severing oftissue clamped in the surgical end effector 12312. As shown in theillustrated embodiment, the surgical end effector 12312 may include, inaddition to the previously-mentioned elongated channel 12322 and anvil12324, a cutting instrument 12332 that has a sled portion 12333 formedthereon, a surgical staple cartridge 12334 that is seated in theelongated channel 12322, and a rotary end effector drive shaft 12336that has a helical screw thread formed thereon. The cutting instrument12332 may be, for example, a knife. As will be discussed in furtherdetail below, rotation of the end effector drive shaft 12336 will causethe cutting instrument 12332 and sled portion 12333 to axially travelthrough the surgical staple cartridge 12334 to move between a startingposition and an ending position. The direction of axial travel of thecutting instrument 12332 depends upon the direction in which the endeffector drive shaft 12336 is rotated. The anvil 12324 may be pivotablyopened and closed at a pivot point 12325 connected to the proximate endof the elongated channel 12322. The anvil 12324 may also include a tab12327 at its proximate end that operably interfaces with a component ofthe mechanical closure system (described further below) to open andclose the anvil 12324. When the end effector drive shaft 12336 isrotated, the cutting instrument 12332 and sled 12333 will travellongitudinally through the surgical staple cartridge 12334 from thestarting position to the ending position, thereby cutting tissue clampedwithin the surgical end effector 12312. The movement of the sled 12333through the surgical staple cartridge 12334 causes the staples thereinto be driven through the severed tissue and against the closed anvil12324, which turns the staples to fasten the severed tissue. In oneform, the elongated channel 12322 and the anvil 12324 may be made of anelectrically conductive material (such as metal) so that they may serveas part of the antenna that communicates with sensor(s) in the endeffector, as described above. The surgical staple cartridge 12334 couldbe made of a nonconductive material (such as plastic) and the sensor maybe connected to or disposed in the surgical staple cartridge 12334, asdescribed above.

It should be noted that although the embodiments of the surgical tool12300 described herein employ a surgical end effector 12312 that staplesthe severed tissue, in other embodiments different techniques forfastening or sealing the severed tissue may be used. For example, endeffectors that use RF energy or adhesives to fasten the severed tissuemay also be used. U.S. Pat. No. 5,709,680, entitled “ElectrosurgicalHemostatic Device” to Yates et al., and U.S. Pat. No. 5,688,270,entitled “Electrosurgical Hemostatic Device With Recessed And/Or OffsetElectrodes” to Yates et al., which are incorporated herein by reference,discloses cutting instruments that use RF energy to fasten the severedtissue. U.S. patent application Ser. No. 11/267,811 to Morgan et al. andU.S. patent application Ser. No. 11/267,363 to Shelton et al., which arealso incorporated herein by reference, disclose cutting instruments thatuse adhesives to fasten the severed tissue. Accordingly, although thedescription herein refers to cutting/stapling operations and the like,it should be recognized that this is an exemplary embodiment and is notmeant to be limiting. Other tissue-fastening techniques may also beused.

In the illustrated embodiment, the surgical end effector 12312 iscoupled to an elongated shaft assembly 12308 that is coupled to a toolmounting portion 12460 and defines a longitudinal tool axis LT-LT. Inthis embodiment, the elongated shaft assembly 12308 does not include anarticulation joint. Those of ordinary skill in the art will understandthat other embodiments may have an articulation joint therein. In atleast one embodiment, the elongated shaft assembly 12308 comprises ahollow outer tube 12340 that is rotatably supported on a tool mountingplate 12462 of a tool mounting portion 12460 as will be discussed infurther detail below. In various embodiments, the elongated shaftassembly 12308 further includes a distal spine shaft 12350. Distal spineshaft 12350 has a distal end portion 12354 that is coupled to, orotherwise integrally formed with, a distal stationary base portion 12360that is non-movably coupled to the channel 12322. See FIGS. 118-120.

As shown in FIG. 115, the distal spine shaft 12350 has a proximal endportion 12351 that is slidably received within a slot 12355 in aproximal spine shaft 12353 that is non-movably supported within thehollow outer tube 12340 by at least one support collar 12357. As can befurther seen in FIGS. 118 and 119, the surgical tool 12300 includes aclosure tube 12370 that is constrained to only move axially relative tothe distal stationary base portion 12360. The closure tube 12370 has aproximal end 12372 that has an internal thread 12374 formed therein thatis in threaded engagement with a transmission arrangement, generallydepicted as 12375 that is operably supported on the tool mounting plate12462. In various forms, the transmission arrangement 12375 includes arotary drive shaft assembly, generally designated as 12381. Whenrotated, the rotary drive shaft assembly 12381 will cause the closuretube 12370 to move axially as will be describe in further detail below.In at least one form, the rotary drive shaft assembly 12381 includes aclosure drive nut 12382 of a closure clutch assembly generallydesignated as 12380. More specifically, the closure drive nut 12382 hasa proximal end portion 12384 that is rotatably supported relative to theouter tube 12340 and is in threaded engagement with the closure tube12370. For assembly purposes, the proximal end portion 12384 may bethreadably attached to a retention ring 12386. Retention ring 12386, incooperation with an end 12387 of the closure drive nut 12382, defines anannular slot 12388 into which a shoulder 12392 of a locking collar 12390extends. The locking collar 12390 is non-movably attached (e.g., welded,glued, etc.) to the end of the outer tube 12340. Such arrangement servesto affix the closure drive nut 12382 to the outer tube 12340 whileenabling the closure drive nut 12382 to rotate relative to the outertube 12340. The closure drive nut 12382 further has a distal end 12383that has a threaded portion 12385 that threadably engages the internalthread 12374 of the closure tube 12370. Thus, rotation of the closuredrive nut 12382 will cause the closure tube 12370 to move axially asrepresented by arrow “D” in FIG. 119.

Closure of the anvil 12324 and actuation of the cutting instrument 12332are accomplished by control motions that are transmitted by a hollowdrive sleeve 12400. As can be seen in FIGS. 118 and 119, the hollowdrive sleeve 12400 is rotatably and slidably received on the distalspine shaft 12350. The drive sleeve 12400 has a proximal end portion12401 that is rotatably mounted to the proximal spine shaft 12353 thatprotrudes from the tool mounting portion 12460 such that the drivesleeve 12400 may rotate relative thereto. See FIG. 118. As can also beseen in FIGS. 118-120, the drive sleeve 12400 is rotated about thelongitudinal tool axis “LT-LT” by a drive shaft 12440. The drive shaft12440 has a drive gear 12444 that is attached to its distal end 12442and is in meshing engagement with a driven gear 12450 that is attachedto the drive sleeve 12400.

The drive sleeve 12400 further has a distal end portion 12402 that iscoupled to a closure clutch 12410 portion of the closure clutch assembly12380 that has a proximal face 12412 and a distal face 12414. Theproximal face 12412 has a series of proximal teeth 12416 formed thereonthat are adapted for selective engagement with corresponding proximalteeth cavities 12418 formed in the proximal end portion 12384 of theclosure drive nut 12382. Thus, when the proximal teeth 12416 are inmeshing engagement with the proximal teeth cavities 12418 in the closuredrive nut 12382, rotation of the drive sleeve 12400 will result inrotation of the closure drive nut 12382 and ultimately cause the closuretube 12370 to move axially as will be discussed in further detail below.

As can be most particularly seen in FIGS. 118 and 119, the distal face12414 of the drive clutch portion 12410 has a series of distal teeth12415 formed thereon that are adapted for selective engagement withcorresponding distal teeth cavities 12426 formed in a face plate portion12424 of a knife drive shaft assembly 12420. In various embodiments, theknife drive shaft assembly 12420 comprises a hollow knife shaft segment12430 that is rotatably received on a corresponding portion of thedistal spine shaft 12350 that is attached to or protrudes from thestationary base 12360. When the distal teeth 12415 of the closure clutchportion 12410 are in meshing engagement with the distal teeth cavities12426 in the face plate portion 12424, rotation of the drive sleeve12400 will result in rotation of the drive shaft segment 12430 about thestationary shaft 12350. As can be seen in FIGS. 118-120, a knife drivegear 12432 is attached to the drive shaft segment 12430 and is meshingengagement with a drive knife gear 12434 that is attached to the endeffector drive shaft 12336. Thus, rotation of the drive shaft segment12430 will result in the rotation of the end effector drive shaft 12336to drive the cutting instrument 12332 and sled 12333 distally throughthe surgical staple cartridge 12334 to cut and staple tissue clampedwithin the surgical end effector 12312. The sled 12333 may be made of,for example, plastic, and may have a sloped distal surface. As the sled12333 traverses the elongated channel 12322, the sloped forward surfaceof the sled 12333 pushes up or “drive” the staples in the surgicalstaple cartridge 12334 through the clamped tissue and against the anvil12324. The anvil 12324 turns or “forms” the staples, thereby staplingthe severed tissue. As used herein, the term “fire” refers to theinitiation of actions required to drive the cutting instrument and sledportion in a distal direction through the surgical staple cartridge tocut the tissue clamped in the surgical end effector and drive thestaples through the severed tissue.

In use, it may be desirable to rotate the surgical end effector 12312about the longitudinal tool axis LT-LT. In at least one embodiment, thetransmission arrangement 12375 includes a rotational transmissionassembly 12465 that is configured to receive a corresponding rotaryoutput motion from the tool drive assembly 11010 of the robotic system11000 and convert that rotary output motion to a rotary control motionfor rotating the elongated shaft assembly 12308 (and surgical endeffector 12312) about the longitudinal tool axis LT-LT. As can be seenin FIG. 121, a proximal end 12341 of the outer tube 12340 is rotatablysupported within a cradle arrangement 12343 attached to the toolmounting plate 12462 of the tool mounting portion 12460. A rotation gear12345 is formed on or attached to the proximal end 12341 of the outertube 12340 of the elongated shaft assembly 12308 for meshing engagementwith a rotation gear assembly 12470 operably supported on the toolmounting plate 12462. In at least one embodiment, a rotation drive gear12472 is coupled to a corresponding first one of the driven discs orelements 11304 on the adapter side of the tool mounting plate 12462 whenthe tool mounting portion 12460 is coupled to the tool drive assembly11010. See FIGS. 105 and 121. The rotation drive assembly 12470 furthercomprises a rotary driven gear 12474 that is rotatably supported on thetool mounting plate 12462 in meshing engagement with the rotation gear12345 and the rotation drive gear 12472. Application of a first rotaryoutput motion from the robotic system 11000 through the tool driveassembly 11010 to the corresponding driven element 11304 will therebycause rotation of the rotation drive gear 12472 by virtue of beingoperably coupled thereto. Rotation of the rotation drive gear 12472ultimately results in the rotation of the elongated shaft assembly 12308(and the end effector 12312) about the longitudinal tool axis LT-LT(primary rotary motion).

Closure of the anvil 12324 relative to the staple cartridge 12034 isaccomplished by axially moving the closure tube 12370 in the distaldirection “DD”. Axial movement of the closure tube 12370 in the distaldirection “DD” is accomplished by applying a rotary control motion tothe closure drive nut 12382. To apply the rotary control motion to theclosure drive nut 12382, the closure clutch 12410 must first be broughtinto meshing engagement with the proximal end portion 12384 of theclosure drive nut 12382. In various embodiments, the transmissionarrangement 12375 further includes a shifter drive assembly 12480 thatis operably supported on the tool mounting plate 12462. Morespecifically and with reference to FIG. 121, it can be seen that aproximal end portion 12359 of the proximal spine portion 12353 extendsthrough the rotation gear 12345 and is rotatably coupled to a shiftergear rack 12481 that is slidably affixed to the tool mounting plate12462 through slots 12482. The shifter drive assembly 12480 furthercomprises a shifter drive gear 12483 that is coupled to a correspondingsecond one of the driven discs or elements 11304 on the adapter side ofthe tool mounting plate 12462 when the tool mounting portion 12460 iscoupled to the tool holder 11270. See FIGS. 105 and 121. The shifterdrive assembly 12480 further comprises a shifter driven gear 12478 thatis rotatably supported on the tool mounting plate 12462 in meshingengagement with the shifter drive gear 12483 and the shifter rack gear12482. Application of a second rotary output motion from the roboticsystem 11000 through the tool drive assembly 11010 to the correspondingdriven element 11304 will thereby cause rotation of the shifter drivegear 12483 by virtue of being operably coupled thereto. Rotation of theshifter drive gear 12483 ultimately results in the axial movement of theshifter gear rack 12482 and the proximal spine portion 12353 as well asthe drive sleeve 12400 and the closure clutch 12410 attached thereto.The direction of axial travel of the closure clutch 12410 depends uponthe direction in which the shifter drive gear 12483 is rotated by therobotic system 11000. Thus, rotation of the shifter drive gear 12483 ina first rotary direction will result in the axial movement of theclosure clutch 12410 in the proximal direction “PD” to bring theproximal teeth 12416 into meshing engagement with the proximal teethcavities 12418 in the closure drive nut 12382. Conversely, rotation ofthe shifter drive gear 12483 in a second rotary direction (opposite tothe first rotary direction) will result in the axial movement of theclosure clutch 12410 in the distal direction “DD” to bring the distalteeth 12415 into meshing engagement with corresponding distal teethcavities 12426 formed in the face plate portion 12424 of the knife driveshaft assembly 12420.

Once the closure clutch 12410 has been brought into meshing engagementwith the closure drive nut 12382, the closure drive nut 12382 is rotatedby rotating the closure clutch 12410. Rotation of the closure clutch12410 is controlled by applying rotary output motions to a rotary drivetransmission portion 12490 of transmission arrangement 12375 that isoperably supported on the tool mounting plate 12462 as shown in FIG.121. In at least one embodiment, the rotary drive transmission 12490includes a rotary drive assembly 12490′ that includes a gear 12491 thatis coupled to a corresponding third one of the driven discs or elements11304 on the adapter side of the tool mounting plate 12462 when the toolmounting portion 12460 is coupled to the tool holder 11270. See FIGS.105 and 121. The rotary drive transmission 12490 further comprises afirst rotary driven gear 12492 that is rotatably supported on the toolmounting plate 12462 in meshing engagement with a second rotary drivengear 12493 and the rotary drive gear 12491. The second rotary drivengear 12493 is coupled to a proximal end portion 12443 of the drive shaft12440.

Rotation of the rotary drive gear 12491 in a first rotary direction willresult in the rotation of the drive shaft 12440 in a first direction.Conversely, rotation of the rotary drive gear 12491 in a second rotarydirection (opposite to the first rotary direction) will cause the driveshaft 12440 to rotate in a second direction. As indicated above, thedrive shaft 12440 has a drive gear 12444 that is attached to its distalend 12442 and is in meshing engagement with a driven gear 12450 that isattached to the drive sleeve 12400. Thus, rotation of the drive shaft12440 results in rotation of the drive sleeve 12400.

A method of operating the surgical tool 12300 will now be described.Once the tool mounting portion 12462 has been operably coupled to thetool holder 11270 of the robotic system 11000 and oriented into positionadjacent the target tissue to be cut and stapled, if the anvil 12334 isnot already in the open position (FIG. 118), the robotic system 11000may apply the first rotary output motion to the shifter drive gear 12483which results in the axial movement of the closure clutch 12410 intomeshing engagement with the closure drive nut 12382 (if it is notalready in meshing engagement therewith). See FIG. 119. Once thecontroller 11001 of the robotic system 11000 has confirmed that theclosure clutch 12410 is meshing engagement with the closure drive nut12382 (e.g., by means of sensor(s)) in the surgical end effector 12312that are in communication with the robotic control system), the roboticcontroller 11001 may then apply a second rotary output motion to therotary drive gear 12492 which, as was described above, ultimatelyresults in the rotation of the rotary drive nut 12382 in the firstdirection which results in the axial travel of the closure tube 12370 inthe distal direction “DD”. As the closure tube 12370 moved in the distaldirection, it contacts a portion of the anvil 12323 and causes the anvil12324 to pivot to the closed position to clamp the target tissue betweenthe anvil 12324 and the surgical staple cartridge 12334. Once therobotic controller 11001 determines that the anvil 12334 has beenpivoted to the closed position by corresponding sensor(s) in thesurgical end effector 12312 in communication therewith, the roboticsystem 11000 discontinues the application of the second rotary outputmotion to the rotary drive gear 12491. The robotic controller 11001 mayalso provide the surgeon with an indication that the anvil 12334 hasbeen fully closed. The surgeon may then initiate the firing procedure.In alternative embodiments, the firing procedure may be automaticallyinitiated by the robotic controller 11001. The robotic controller 11001then applies the primary rotary control motion 12483 to the shifterdrive gear 12483 which results in the axial movement of the closureclutch 12410 into meshing engagement with the face plate portion 12424of the knife drive shaft assembly 12420. See FIG. 120. Once thecontroller 11001 of the robotic system 11000 has confirmed that theclosure clutch 12410 is meshing engagement with the face plate portion12424 (by means of sensor(s)) in the end effector 12312 that are incommunication with the robotic controller 11001), the robotic controller11001 may then apply the second rotary output motion to the rotary drivegear 12492 which, as was described above, ultimately results in theaxial movement of the cutting instrument 12332 and sled portion 12333 inthe distal direction “DD” through the surgical staple cartridge 12334.As the cutting instrument 12332 moves distally through the surgicalstaple cartridge 12334, the tissue clamped therein is severed. As thesled portion 12333 is driven distally, it causes the staples within thesurgical staple cartridge to be driven through the severed tissue intoforming contact with the anvil 12324. Once the robotic controller 11001has determined that the cutting instrument 12324 has reached the endposition within the surgical staple cartridge 12334 (by means ofsensor(s)) in the end effector 12312 that are in communication with therobotic controller 11001), the robotic controller 11001 discontinues theapplication of the second rotary output motion to the rotary drive gear12491. Thereafter, the robotic controller 11001 applies the secondaryrotary output motion to the rotary drive gear 12491 which ultimatelyresults in the axial travel of the cutting instrument 12332 and sledportion 12333 in the proximal direction “PD” to the starting position.Once the robotic controller 11001 has determined that the cuttinginstrument 12324 has reached the staring position by means of sensor(s)in the surgical end effector 12312 that are in communication with therobotic controller 11001, the robotic controller 11001 discontinues theapplication of the secondary rotary output motion to the rotary drivegear 12491. Thereafter, the robotic controller 11001 applies the primaryrotary output motion to the shifter drive gear 12483 to cause theclosure clutch 12410 to move into engagement with the rotary drive nut12382. Once the closure clutch 12410 has been moved into meshingengagement with the rotary drive nut 12382, the robotic controller 11001then applies the secondary output motion to the rotary drive gear 12491which ultimately results in the rotation of the rotary drive nut 12382in the second direction to cause the closure tube 12370 to move in theproximal direction “PD”. As can be seen in FIGS. 118-120, the closuretube 12370 has an opening 12345 therein that engages the tab 12327 onthe anvil 12324 to cause the anvil 12324 to pivot to the open position.In alternative embodiments, a spring may also be employed to pivot theanvil 12324 to the open position when the closure tube 12370 has beenreturned to the starting position (FIG. 118).

FIGS. 122-126 illustrate yet another surgical tool 12500 that may beeffectively employed in connection with the robotic system 11000. Invarious forms, the surgical tool 12500 includes a surgical end effector12512 that includes a “first portion” in the form of an elongatedchannel 12522 and a “second movable portion” in the form of a pivotallytranslatable clamping member, such as an anvil 12524, which aremaintained at a spacing that assures effective stapling and severing oftissue clamped in the surgical end effector 12512. As shown in theillustrated embodiment, the surgical end effector 12512 may include, inaddition to the previously-mentioned elongated channel 12522 and anvil12524, a “third movable portion” in the form of a cutting instrument12532, a sled (not shown), and a surgical staple cartridge 12534 that isremovably seated in the elongated channel 12522. The cutting instrument12532 may be, for example, a knife. The anvil 12524 may be pivotablyopened and closed at a pivot point 12525 connected to the proximate endof the elongated channel 12522. The anvil 12524 may also include a tab12527 at its proximate end that is configured to operably interface witha component of the mechanical closure system (described further below)to open and close the anvil 12524. When actuated, the knife 12532 andsled travel longitudinally along the elongated channel 12522, therebycutting tissue clamped within the surgical end effector 12512. Themovement of the sled along the elongated channel 12522 causes thestaples of the surgical staple cartridge 12534 to be driven through thesevered tissue and against the closed anvil 12524, which turns thestaples to fasten the severed tissue. In one form, the elongated channel12522 and the anvil 12524 may be made of an electrically conductivematerial (such as metal) so that they may serve as part of the antennathat communicates with sensor(s) in the surgical end effector, asdescribed above. The surgical staple cartridge 12534 could be made of anonconductive material (such as plastic) and the sensor may be connectedto or disposed in the surgical staple cartridge 12534, as describedabove.

It should be noted that although the embodiments of the surgical tool12500 described herein employ a surgical end effector 12512 that staplesthe severed tissue, in other embodiments different techniques forfastening or sealing the severed tissue may be used. For example, endeffectors that use RF energy or adhesives to fasten the severed tissuemay also be used. U.S. Pat. No. 5,709,680, entitled “ElectrosurgicalHemostatic Device” to Yates et al., and U.S. Pat. No. 5,688,270,entitled “Electrosurgical Hemostatic Device With Recessed And/Or OffsetElectrodes” to Yates et al., which are incorporated herein by reference,discloses cutting instruments that use RF energy to fasten the severedtissue. U.S. patent application Ser. No. 11/267,811 to Morgan et al. andU.S. patent application Ser. No. 11/267,363 to Shelton et al., which arealso incorporated herein by reference, disclose cutting instruments thatuse adhesives to fasten the severed tissue. Accordingly, although thedescription herein refers to cutting/stapling operations and the like,it should be recognized that this is an exemplary embodiment and is notmeant to be limiting. Other tissue-fastening techniques may also beused.

In the illustrated embodiment, the elongated channel 12522 of thesurgical end effector 12512 is coupled to an elongated shaft assembly12508 that is coupled to a tool mounting portion 12600. In at least oneembodiment, the elongated shaft assembly 12508 comprises a hollow spinetube 12540 that is non-movably coupled to a tool mounting plate 12602 ofthe tool mounting portion 12600. As can be seen in FIGS. 123 and 124,the proximal end 12523 of the elongated channel 12522 comprises a hollowtubular structure configured to be attached to the distal end 12541 ofthe spine tube 12540. In one embodiment, for example, the proximal end12523 of the elongated channel 12522 is welded or glued to the distalend of the spine tube 12540.

As can be further seen in FIGS. 123 and 124, in at least onenon-limiting embodiment, the surgical tool 12500 further includes anaxially movable actuation member in the form of a closure tube 12550that is constrained to move axially relative to the elongated channel12522 and the spine tube 12540. The closure tube 12550 has a proximalend 12552 that has an internal thread 12554 formed therein that is inthreaded engagement with a rotatably movable portion in the form of aclosure drive nut 12560. More specifically, the closure drive nut 12560has a proximal end portion 12562 that is rotatably supported relative tothe elongated channel 12522 and the spine tube 12540. For assemblypurposes, the proximal end portion 12562 is threadably attached to aretention ring 12570. The retention ring 12570 is received in a groove12529 formed between a shoulder 12527 on the proximal end 12523 of theelongated channel 12522 and the distal end 12541 of the spine tube12540. Such arrangement serves to rotatably support the closure drivenut 12560 within the elongated channel 12522. Rotation of the closuredrive nut 12560 will cause the closure tube 12550 to move axially asrepresented by arrow “D” in FIG. 123.

Extending through the spine tube 12540 and the closure drive nut 12560is a drive member which, in at least one embodiment, comprises a knifebar 12580 that has a distal end portion 12582 that is rotatably coupledto the cutting instrument 12532 such that the knife bar 12580 may rotaterelative to the cutting instrument 12582. As can be seen in FIG.123-125, the closure drive nut 12560 has a slot 12564 therein throughwhich the knife bar 12580 can slidably extend. Such arrangement permitsthe knife bar 12580 to move axially relative to the closure drive nut12560. However, rotation of the knife bar 12580 about the longitudinaltool axis LT-LT will also result in the rotation of the closure drivenut 12560. The axial direction in which the closure tube 12550 movesultimately depends upon the direction in which the knife bar 12580 andthe closure drive nut 12560 are rotated. As the closure tube 12550 isdriven distally, the distal end thereof will contact the anvil 12524 andcause the anvil 12524 to pivot to a closed position. Upon application ofan opening rotary output motion from the robotic system 11000, theclosure tube 12550 will be driven in the proximal direction “PD” andpivot the anvil 12524 to the open position by virtue of the engagementof the tab 12527 with the opening 12555 in the closure tube 12550.

In use, it may be desirable to rotate the surgical end effector 12512about the longitudinal tool axis LT-LT. In at least one embodiment, thetool mounting portion 12600 is configured to receive a correspondingfirst rotary output motion from the robotic system 11000 and convertthat first rotary output motion to a rotary control motion for rotatingthe elongated shaft assembly 12508 about the longitudinal tool axisLT-LT. As can be seen in FIG. 121, a proximal end 12542 of the hollowspine tube 12540 is rotatably supported within a cradle arrangement12603 attached to a tool mounting plate 12602 of the tool mountingportion 12600. Various embodiments of the surgical tool 12500 furtherinclude a transmission arrangement, generally depicted as 12605, that isoperably supported on the tool mounting plate 12602. In various formsthe transmission arrangement 12605 include a rotation gear 12544 that isformed on or attached to the proximal end 12542 of the spine tube 12540for meshing engagement with a rotation drive assembly 12610 that isoperably supported on the tool mounting plate 12602. In at least oneembodiment, a rotation drive gear 12612 is coupled to a correspondingfirst one of the rotational bodies, driven discs or elements 11304 onthe adapter side of the tool mounting plate 12602 when the tool mountingportion 12600 is coupled to the tool holder 11270. See FIGS. 105 and126. The rotation drive assembly 12610 further comprises a rotary drivengear 12614 that is rotatably supported on the tool mounting plate 12602in meshing engagement with the rotation gear 12544 and the rotationdrive gear 12612. Application of a first rotary output motion from therobotic system 11000 through the tool drive assembly 11010 to thecorresponding driven rotational body 11304 will thereby cause rotationof the rotation drive gear 12612 by virtue of being operably coupledthereto. Rotation of the rotation drive gear 12612 ultimately results inthe rotation of the elongated shaft assembly 12508 (and the end effector12512) about the longitudinal tool axis LT-LT.

Closure of the anvil 12524 relative to the surgical staple cartridge12534 is accomplished by axially moving the closure tube 12550 in thedistal direction “DD”. Axial movement of the closure tube 12550 in thedistal direction “DD” is accomplished by applying a rotary controlmotion to the closure drive nut 12382. In various embodiments, theclosure drive nut 12560 is rotated by applying a rotary output motion tothe knife bar 12580. Rotation of the knife bar 12580 is controlled byapplying rotary output motions to a rotary closure system 12620 that isoperably supported on the tool mounting plate 12602 as shown in FIG.126. In at least one embodiment, the rotary closure system 12620includes a closure drive gear 12622 that is coupled to a correspondingsecond one of the driven rotatable body portions discs or elements 11304on the adapter side of the tool mounting plate 12462 when the toolmounting portion 12600 is coupled to the tool holder 11270. See FIGS.105 and 126. The closure drive gear 12622, in at least one embodiment,is in meshing driving engagement with a closure gear train, generallydepicted as 12623. The closure gear drive rain 12623 comprises a firstdriven closure gear 12624 that is rotatably supported on the toolmounting plate 12602. The first closure driven gear 12624 is attached toa second closure driven gear 12626 by a drive shaft 12628. The secondclosure driven gear 12626 is in meshing engagement with a third closuredriven gear 12630 that is rotatably supported on the tool mounting plate12602. Rotation of the closure drive gear 12622 in a second rotarydirection will result in the rotation of the third closure driven gear12630 in a second direction. Conversely, rotation of the closure drivegear 12483 in a secondary rotary direction (opposite to the secondrotary direction) will cause the third closure driven gear 12630 torotate in a secondary direction.

As can be seen in FIG. 126, a drive shaft assembly 12640 is coupled to aproximal end of the knife bar 12580. In various embodiments, the driveshaft assembly 12640 includes a proximal portion 12642 that has a squarecross-sectional shape. The proximal portion 12642 is configured toslideably engage a correspondingly shaped aperture in the third drivengear 12630. Such arrangement results in the rotation of the drive shaftassembly 12640 (and knife bar 12580) when the third driven gear 12630 isrotated. The drive shaft assembly 12640 is axially advanced in thedistal and proximal directions by a knife drive assembly 12650. One formof the knife drive assembly 12650 comprises a rotary drive gear 12652that is coupled to a corresponding third one of the driven rotatablebody portions, discs or elements 11304 on the adapter side of the toolmounting plate 12462 when the tool mounting portion 12600 is coupled tothe tool holder 11270. See FIGS. 105 and 126. The rotary driven gear12652 is in meshing driving engagement with a gear train, generallydepicted as 12653. In at least one form, the gear train 12653 furthercomprises a first rotary driven gear assembly 12654 that is rotatablysupported on the tool mounting plate 12602. The first rotary driven gearassembly 12654 is in meshing engagement with a third rotary driven gearassembly 12656 that is rotatably supported on the tool mounting plate12602 and which is in meshing engagement with a fourth rotary drivengear assembly 12658 that is in meshing engagement with a threadedportion 12644 of the drive shaft assembly 12640. Rotation of the rotarydrive gear 12652 in a third rotary direction will result in the axialadvancement of the drive shaft assembly 12640 and knife bar 12580 in thedistal direction “DD”. Conversely, rotation of the rotary drive gear12652 in a tertiary rotary direction (opposite to the third rotarydirection) will cause the drive shaft assembly 12640 and the knife bar12580 to move in the proximal direction.

A method of operating the surgical tool 12500 will now be described.Once the tool mounting portion 12600 has been operably coupled to thetool holder 11270 of the robotic system 11000, the robotic system 11000can orient the surgical end effector 12512 in position adjacent thetarget tissue to be cut and stapled. If the anvil 12524 is not alreadyin the open position (FIG. 123), the robotic system 11000 may apply thesecond rotary output motion to the closure drive gear 12622 whichresults in the rotation of the knife bar 12580 in a second direction.Rotation of the knife bar 12580 in the second direction results in therotation of the closure drive nut 12560 in a second direction. As theclosure drive nut 12560 rotates in the second direction, the closuretube 12550 moves in the proximal direction “PD”. As the closure tube12550 moves in the proximal direction “PD”, the tab 12527 on the anvil12524 interfaces with the opening 12555 in the closure tube 12550 andcauses the anvil 12524 to pivot to the open position. In addition or inalternative embodiments, a spring (not shown) may be employed to pivotthe anvil 12354 to the open position when the closure tube 12550 hasbeen returned to the starting position (FIG. 123). The opened surgicalend effector 12512 may then be manipulated by the robotic system 11000to position the target tissue between the open anvil 12524 and thesurgical staple cartridge 12534. Thereafter, the surgeon may initiatethe closure process by activating the robotic control system 11000 toapply the second rotary output motion to the closure drive gear 12622which, as was described above, ultimately results in the rotation of theclosure drive nut 12382 in the second direction which results in theaxial travel of the closure tube 12250 in the distal direction “DD”. Asthe closure tube 12550 moves in the distal direction, it contacts aportion of the anvil 12524 and causes the anvil 12524 to pivot to theclosed position to clamp the target tissue between the anvil 12524 andthe staple cartridge 12534. Once the robotic controller 11001 determinesthat the anvil 12524 has been pivoted to the closed position bycorresponding sensor(s) in the end effector 12512 that are incommunication therewith, the robotic controller 11001 discontinues theapplication of the second rotary output motion to the closure drive gear12622. The robotic controller 11001 may also provide the surgeon with anindication that the anvil 12524 has been fully closed. The surgeon maythen initiate the firing procedure. In alternative embodiments, thefiring procedure may be automatically initiated by the roboticcontroller 11001.

After the robotic controller 11001 has determined that the anvil 12524is in the closed position, the robotic controller 11001 then applies thethird rotary output motion to the rotary drive gear 12652 which resultsin the axial movement of the drive shaft assembly 12640 and knife bar12580 in the distal direction “DD”. As the cutting instrument 12532moves distally through the surgical staple cartridge 12534, the tissueclamped therein is severed. As the sled portion (not shown) is drivendistally, it causes the staples within the surgical staple cartridge12534 to be driven through the severed tissue into forming contact withthe anvil 12524. Once the robotic controller 11001 has determined thatthe cutting instrument 12532 has reached the end position within thesurgical staple cartridge 12534 by means of sensor(s) in the surgicalend effector 12512 that are in communication with the robotic controller11001, the robotic controller 11001 discontinues the application of thesecond rotary output motion to the rotary drive gear 12652. Thereafter,the robotic controller 11001 applies the secondary rotary control motionto the rotary drive gear 12652 which ultimately results in the axialtravel of the cutting instrument 12532 and sled portion in the proximaldirection “PD” to the starting position. Once the robotic controller1001 has determined that the cutting instrument 12524 has reached thestaring position by means of sensor(s) in the end effector 12512 thatare in communication with the robotic controller 11001, the roboticcontroller 11001 discontinues the application of the secondary rotaryoutput motion to the rotary drive gear 12652. Thereafter, the roboticcontroller 11001 may apply the secondary rotary output motion to theclosure drive gear 12622 which results in the rotation of the knife bar12580 in a secondary direction. Rotation of the knife bar 12580 in thesecondary direction results in the rotation of the closure drive nut12560 in a secondary direction. As the closure drive nut 12560 rotatesin the secondary direction, the closure tube 12550 moves in the proximaldirection “PD” to the open position.

FIGS. 127-132B illustrate yet another surgical tool 12700 that may beeffectively employed in connection with the robotic system 11000. Invarious forms, the surgical tool 12700 includes a surgical end effector12712 that includes a “first portion” in the form of an elongatedchannel 12722 and a “second movable portion” in on form comprising apivotally translatable clamping member, such as an anvil 12724, whichare maintained at a spacing that assures effective stapling and severingof tissue clamped in the surgical end effector 12712. As shown in theillustrated embodiment, the surgical end effector 12712 may include, inaddition to the previously-mentioned channel 12722 and anvil 12724, a“third movable portion” in the form of a cutting instrument 12732, asled (not shown), and a surgical staple cartridge 12734 that isremovably seated in the elongated channel 12722. The cutting instrument12732 may be, for example, a knife. The anvil 12724 may be pivotablyopened and closed at a pivot point 12725 connected to the proximal endof the elongated channel 12722. The anvil 12724 may also include a tab12727 at its proximal end that interfaces with a component of themechanical closure system (described further below) to open and closethe anvil 12724. When actuated, the knife 12732 and sled to travellongitudinally along the elongated channel 12722, thereby cutting tissueclamped within the surgical end effector 12712. The movement of the sledalong the elongated channel 12722 causes the staples of the surgicalstaple cartridge 12734 to be driven through the severed tissue andagainst the closed anvil 12724, which turns the staples to fasten thesevered tissue. In one form, the elongated channel 12722 and the anvil12724 may be made of an electrically conductive material (such as metal)so that they may serve as part of the antenna that communicates withsensor(s) in the surgical end effector, as described above. The surgicalstaple cartridge 12734 could be made of a nonconductive material (suchas plastic) and the sensor may be connected to or disposed in thesurgical staple cartridge 12734, as described above.

It should be noted that although the embodiments of the surgical tool12500 described herein employ a surgical end effector 12712 that staplesthe severed tissue, in other embodiments different techniques forfastening or sealing the severed tissue may be used. For example, endeffectors that use RF energy or adhesives to fasten the severed tissuemay also be used. U.S. Pat. No. 5,709,680, entitled “ElectrosurgicalHemostatic Device” to Yates et al., and U.S. Pat. No. 5,688,270,entitled “Electrosurgical Hemostatic Device With Recessed And/Or OffsetElectrodes” to Yates et al., which are incorporated herein by reference,discloses cutting instruments that use RF energy to fasten the severedtissue. U.S. patent application Ser. No. 11/267,811 to Morgan et al. andU.S. patent application Ser. No. 11/267,363 to Shelton et al., which arealso incorporated herein by reference, disclose cutting instruments thatuse adhesives to fasten the severed tissue. Accordingly, although thedescription herein refers to cutting/stapling operations and the like,it should be recognized that this is an exemplary embodiment and is notmeant to be limiting. Other tissue-fastening techniques may also beused.

In the illustrated embodiment, the elongated channel 12722 of thesurgical end effector 12712 is coupled to an elongated shaft assembly12708 that is coupled to a tool mounting portion 12900. Although notshown, the elongated shaft assembly 12708 may include an articulationjoint to permit the surgical end effector 12712 to be selectivelyarticulated about an axis that is substantially transverse to the toolaxis LT-LT. In at least one embodiment, the elongated shaft assembly12708 comprises a hollow spine tube 12740 that is non-movably coupled toa tool mounting plate 12902 of the tool mounting portion 12900. As canbe seen in FIGS. 128 and 129, the proximal end 12723 of the elongatedchannel 12722 comprises a hollow tubular structure that is attached tothe spine tube 12740 by means of a mounting collar 12790. Across-sectional view of the mounting collar 12790 is shown in FIG. 130.In various embodiments, the mounting collar 12790 has a proximal flangedend 12791 that is configured for attachment to the distal end of thespine tube 12740. In at least one embodiment, for example, the proximalflanged end 12791 of the mounting collar 12790 is welded or glued to thedistal end of the spine tube 12740. As can be further seen in FIGS. 128and 129, the mounting collar 12790 further has a mounting hub portion12792 that is sized to receive the proximal end 12723 of the elongatedchannel 12722 thereon. The proximal end 12723 of the elongated channel12722 is non-movably attached to the mounting hub portion 12792 by, forexample, welding, adhesive, etc.

As can be further seen in FIGS. 128 and 129, the surgical tool 12700further includes an axially movable actuation member in the form of aclosure tube 12750 that is constrained to move axially relative to theelongated channel 12722. The closure tube 12750 has a proximal end 12752that has an internal thread 12754 formed therein that is in threadedengagement with a rotatably movable portion in the form of a closuredrive nut 12760. More specifically, the closure drive nut 12760 has aproximal end portion 12762 that is rotatably supported relative to theelongated channel 12722 and the spine tube 12740. For assembly purposes,the proximal end portion 12762 is threadably attached to a retentionring 12770. The retention ring 12770 is received in a groove 12729formed between a shoulder 12727 on the proximal end 12723 of the channel12722 and the mounting hub 12729 of the mounting collar 12790. Sucharrangement serves to rotatably support the closure drive nut 12760within the channel 12722. Rotation of the closure drive nut 12760 willcause the closure tube 12750 to move axially as represented by arrow “D”in FIG. 128.

Extending through the spine tube 12740, the mounting collar 12790, andthe closure drive nut 12760 is a drive member, which in at least oneembodiment, comprises a knife bar 12780 that has a distal end portion12782 that is coupled to the cutting instrument 12732. As can be seen inFIGS. 128 and 129, the mounting collar 12790 has a passage 12793therethrough for permitting the knife bar 12780 to slidably passtherethrough. Similarly, the closure drive nut 12760 has a slot 12764therein through which the knife bar 12780 can slidably extend. Sucharrangement permits the knife bar 12780 to move axially relative to theclosure drive nut 12760.

Actuation of the anvil 12724 is controlled by a rotary driven closureshaft 12800. As can be seen in FIGS. 128 and 129, a distal end portion12802 of the closure drive shaft 12800 extends through a passage 12794in the mounting collar 12790 and a closure gear 12804 is attachedthereto. The closure gear 12804 is configured for driving engagementwith the inner surface 12761 of the closure drive nut 12760. Thus,rotation of the closure shaft 12800 will also result in the rotation ofthe closure drive nut 12760. The axial direction in which the closuretube 12750 moves ultimately depends upon the direction in which theclosure shaft 12800 and the closure drive nut 12760 are rotated. Forexample, in response to one rotary closure motion received from therobotic system 11000, the closure tube 12750 will be driven in thedistal direction “DD”. As the closure tube 12750 is driven distally, theopening 12745 will engage the tab 12727 on the anvil 12724 and cause theanvil 12724 to pivot to a closed position. Upon application of anopening rotary motion from the robotic system 11000, the closure tube12750 will be driven in the proximal direction “PD” and pivot the anvil12724 to the open position. In various embodiments, a spring (not shown)may be employed to bias the anvil 12724 to the open position (FIG. 128).

In use, it may be desirable to rotate the surgical end effector 12712about the longitudinal tool axis LT-LT. In at least one embodiment, thetool mounting portion 12900 is configured to receive a correspondingfirst rotary output motion from the robotic system 11000 for rotatingthe elongated shaft assembly 12708 about the tool axis LT-LT. As can beseen in FIG. 132, a proximal end 12742 of the hollow spine tube 12740 isrotatably supported within a cradle arrangement 12903 and a bearingassembly 12904 that are attached to a tool mounting plate 12902 of thetool mounting portion 12900. A rotation gear 12744 is formed on orattached to the proximal end 12742 of the spine tube 12740 for meshingengagement with a rotation drive assembly 12910 that is operablysupported on the tool mounting plate 12902. In at least one embodiment,a rotation drive gear 12912 is coupled to a corresponding first one ofthe driven discs or elements 11304 on the adapter side of the toolmounting plate 12602 when the tool mounting portion 12600 is coupled tothe tool holder 11270. See FIGS. 105 and 132. The rotation driveassembly 12910 further comprises a rotary driven gear 12914 that isrotatably supported on the tool mounting plate 12902 in meshingengagement with the rotation gear 12744 and the rotation drive gear12912. Application of a first rotary control motion from the roboticsystem 11000 through the tool holder 11270 and the adapter 11240 to thecorresponding driven element 11304 will thereby cause rotation of therotation drive gear 12912 by virtue of being operably coupled thereto.Rotation of the rotation drive gear 12912 ultimately results in therotation of the elongated shaft assembly 12708 (and the end effector2712) about the longitudinal tool axis LT-LT (primary rotary motion).

Closure of the anvil 12724 relative to the staple cartridge 12734 isaccomplished by axially moving the closure tube 12750 in the distaldirection “DD”. Axial movement of the closure tube 12750 in the distaldirection “DD” is accomplished by applying a rotary control motion tothe closure drive nut 12760. In various embodiments, the closure drivenut 12760 is rotated by applying a rotary output motion to the closuredrive shaft 12800. As can be seen in FIG. 132, a proximal end portion12806 of the closure drive shaft 12800 has a driven gear 12808 thereonthat is in meshing engagement with a closure drive assembly 12920. Invarious embodiments, the closure drive system 12920 includes a closuredrive gear 12922 that is coupled to a corresponding second one of thedriven rotational bodies or elements 11304 on the adapter side of thetool mounting plate 12462 when the tool mounting portion 12900 iscoupled to the tool holder 11270. See FIGS. 105 and 132. The closuredrive gear 12922 is supported in meshing engagement with a closure geartrain, generally depicted as 12923. In at least one form, the closuregear rain 12923 comprises a first driven closure gear 12924 that isrotatably supported on the tool mounting plate 12902. The first closuredriven gear 12924 is attached to a second closure driven gear 12926 by adrive shaft 12928. The second closure driven gear 12926 is in meshingengagement with a planetary gear assembly 12930. In various embodiments,the planetary gear assembly 12930 includes a driven planetary closuregear 12932 that is rotatably supported within the bearing assembly 12904that is mounted on tool mounting plate 12902. As can be seen in FIGS.132 and 132B, the proximal end portion 12806 of the closure drive shaft12800 is rotatably supported within the proximal end portion 12742 ofthe spine tube 12740 such that the driven gear 12808 is in meshingengagement with central gear teeth 12934 formed on the planetary gear12932. As can also be seen in FIG. 132A, two additional support gears12936 are attached to or rotatably supported relative to the proximalend portion 12742 of the spine tube 12740 to provide bearing supportthereto. Such arrangement with the planetary gear assembly 12930 servesto accommodate rotation of the spine shaft 12740 by the rotation driveassembly 12910 while permitting the closure driven gear 12808 to remainin meshing engagement with the closure drive system 12920. In addition,rotation of the closure drive gear 12922 in a first direction willultimately result in the rotation of the closure drive shaft 12800 andclosure drive nut 12760 which will ultimately result in the closure ofthe anvil 12724 as described above. Conversely, rotation of the closuredrive gear 12922 in a second opposite direction will ultimately resultin the rotation of the closure drive nut 12760 in an opposite directionwhich results in the opening of the anvil 12724.

As can be seen in FIG. 126, the proximal end 12784 of the knife bar12780 has a threaded shaft portion 12786 attached thereto which is indriving engagement with a knife drive assembly 12940. In variousembodiments, the threaded shaft portion 12786 is rotatably supported bya bearing 12906 attached to the tool mounting plate 12902. Sucharrangement permits the threaded shaft portion 12786 to rotate and moveaxially relative to the tool mounting plate 12902. The knife bar 12780is axially advanced in the distal and proximal directions by the knifedrive assembly 12940. One form of the knife drive assembly 12940comprises a rotary drive gear 12942 that is coupled to a correspondingthird one of the rotatable bodies, driven discs or elements 11304 on theadapter side of the tool mounting plate 12902 when the tool mountingportion 12900 is coupled to the tool holder 11270. See FIGS. 105 and132. The rotary drive gear 12942 is in meshing engagement with a knifegear train, generally depicted as 12943. In various embodiments, theknife gear train 12943 comprises a first rotary driven gear assembly12944 that is rotatably supported on the tool mounting plate 12902. Thefirst rotary driven gear assembly 12944 is in meshing engagement with athird rotary driven gear assembly 12946 that is rotatably supported onthe tool mounting plate 12902 and which is in meshing engagement with afourth rotary driven gear assembly 12948 that is in meshing engagementwith the threaded portion 12786 of the knife bar 12780. Rotation of therotary drive gear 12942 in one direction will result in the axialadvancement of the knife bar 12780 in the distal direction “DD”.Conversely, rotation of the rotary drive gear 12942 in an oppositedirection will cause the knife bar 12780 to move in the proximaldirection. Tool 12700 may otherwise be used as described above.

FIGS. 133 and 134 illustrate a surgical tool embodiment 12700′ that issubstantially identical to tool 12700 that was described in detailabove. However tool 12700′ includes a pressure sensor 12950 that isconfigured to provide feedback to the robotic controller 11001concerning the amount of clamping pressure experienced by the anvil12724. In various embodiments, for example, the pressure sensor maycomprise a spring biased contact switch. For a continuous signal, itwould use either a cantilever beam with a strain gage on it or a domebutton top with a strain gage on the inside. Another version maycomprise an off switch that contacts only at a known desired load. Sucharrangement would include a dome on the based wherein the dome is oneelectrical pole and the base is the other electrical pole. Sucharrangement permits the robotic controller 11001 to adjust the amount ofclamping pressure being applied to the tissue within the surgical endeffector 12712 by adjusting the amount of closing pressure applied tothe anvil 12724. Those of ordinary skill in the art will understand thatsuch pressure sensor arrangement may be effectively employed withseveral of the surgical tool embodiments described herein as well astheir equivalent structures.

FIG. 135 illustrates a portion of another surgical tool 13000 that maybe effectively used in connection with a robotic system 11000. Thesurgical tool 13003 employs on-board motor(s) for powering variouscomponents of a surgical end effector cutting instrument. In at leastone non-limiting embodiment for example, the surgical tool 13000includes a surgical end effector in the form of an endocutter (notshown) that has an anvil (not shown) and surgical staple cartridgearrangement (not shown) of the types and constructions described above.The surgical tool 13000 also includes an elongated shaft (not shown) andanvil closure arrangement (not shown) of the types described above.Thus, this portion of the Detailed Description will not repeat thedescription of those components beyond that which is necessary toappreciate the unique and novel attributes of the various embodiments ofsurgical tool 13000.

In the depicted embodiment, the end effector includes a cuttinginstrument 13002 that is coupled to a knife bar 13003. As can be seen inFIG. 135, the surgical tool 13000 includes a tool mounting portion 13010that includes a tool mounting plate 13012 that is configured tomountingly interface with the adaptor portion 11240′ which is coupled tothe robotic system 11000 in the various manners described above. Thetool mounting portion 13010 is configured to operably support atransmission arrangement 13013 thereon. In at least one embodiment, theadaptor portion 11240′ may be identical to the adaptor portion 11240described in detail above without the powered rotation bodies and discmembers employed by adapter 11240. In other embodiments, the adaptorportion 11240′ may be identical to adaptor portion 11240. Still othermodifications which are considered to be within the spirit and scope ofthe various forms of the present invention may employ one or more of themechanical motions (i.e., rotary motion(s)) from the tool holder portion11270 (as described hereinabove) to power/actuate the transmissionarrangement 13013 while also employing one or more motors within thetool mounting portion 13010 to power one or more other components of thesurgical end effector. In addition, while the end effector of thedepicted embodiment comprises an endocutter, those of ordinary skill inthe art will understand that the unique and novel attributes of thedepicted embodiment may be effectively employed in connection with othertypes of surgical end effectors without departing from the spirit andscope of various forms of the present invention.

In various embodiments, the tool mounting plate 13012 is configured toat least house a first firing motor 13011 for supplying firing andretraction motions to the knife bar 13003 which is coupled to orotherwise operably interfaces with the cutting instrument 13002. Thetool mounting plate 13012 has an array of electrical connecting pins13014 which are configured to interface with the slots 11258 (FIG. 104)in the adapter 11240′. Such arrangement permits the controller 11001 ofthe robotic system 11000 to provide control signals to the electroniccontrol circuit 13020 of the surgical tool 13000. While the interface isdescribed herein with reference to mechanical, electrical, and magneticcoupling elements, it should be understood that a wide variety oftelemetry modalities might be used, including infrared, inductivecoupling, or the like.

Control circuit 13020 is shown in schematic form in FIG. 135. In oneform or embodiment, the control circuit 13020 includes a power supply inthe form of a battery 13022 that is coupled to an on-off solenoidpowered switch 13024. Control circuit 13020 further includes an on/offfiring solenoid 13026 that is coupled to a double pole switch 13028 forcontrolling the rotational direction of the motor 13011. Thus, when thecontroller 11001 of the robotic system 11000 supplies an appropriatecontrol signal, switch 13024 will permit battery 13022 to supply powerto the double pole switch 13028. The controller 11001 of the roboticsystem 11000 will also supply an appropriate signal to the double poleswitch 13028 to supply power to the motor 13011. When it is desired tofire the surgical end effector (i.e., drive the cutting instrument 13002distally through tissue clamped in the surgical end effector, the doublepole switch 13028 will be in a first position. When it is desired toretract the cutting instrument 13002 to the starting position, thedouble pole switch 13028 will be moved to the second position by thecontroller 11001.

Various embodiments of the surgical tool 13000 also employ a gear box13030 that is sized, in cooperation with a firing gear train 13031 that,in at least one non-limiting embodiment, comprises a firing drive gear13032 that is in meshing engagement with a firing driven gear 13034 forgenerating a desired amount of driving force necessary to drive thecutting instrument 13002 through tissue and to drive and form staples inthe various manners described herein. In the embodiment depicted in FIG.135, the driven gear 13034 is coupled to a screw shaft 13036 that is inthreaded engagement with a screw nut arrangement 13038 that isconstrained to move axially (represented by arrow “D”). The screw nutarrangement 13038 is attached to the firing bar 13003. Thus, by rotatingthe screw shaft 13036 in a first direction, the cutting instrument 13002is driven in the distal direction “DD” and rotating the screw shaft inan opposite second direction, the cutting instrument 13002 may beretracted in the proximal direction “PD”.

FIG. 136 illustrates a portion of another surgical tool 13000′ that issubstantially identical to tool 13000 described above, except that thedriven gear 13034 is attached to a drive shaft 13040. The drive shaft13040 is attached to a second driver gear 13042 that is in meshingengagement with a third driven gear 13044 that is in meshing engagementwith a screw 13046 coupled to the firing bar 13003.

FIG. 137 illustrates another surgical tool 13200 that may be effectivelyused in connection with a robotic system 11000. In this embodiment, thesurgical tool 13200 includes a surgical end effector 13212 that in onenon-limiting form, comprises a component portion that is selectivelymovable between first and second positions relative to at least oneother end effector component portion. As will be discussed in furtherdetail below, the surgical tool 13200 employs on-board motors forpowering various components of a transmission arrangement 13305. Thesurgical end effector 13212 includes an elongated channel 13222 thatoperably supports a surgical staple cartridge 13234. The elongatedchannel 13222 has a proximal end 13223 that slidably extends into ahollow elongated shaft assembly 13208 that is coupled to a tool mountingportion 13300. In addition, the surgical end effector 13212 includes ananvil 13224 that is pivotally coupled to the elongated channel 13222 bya pair of trunnions 13225 that are received within correspondingopenings 13229 in the elongated channel 13222. A distal end portion13209 of the shaft assembly 13208 includes an opening 13245 into which atab 13227 on the anvil 13224 is inserted in order to open the anvil13224 as the elongated channel 13222 is moved axially in the proximaldirection “PD” relative to the distal end portion 13209 of the shaftassembly 13208. In various embodiments, a spring (not shown) may beemployed to bias the anvil 13224 to the open position.

As indicated above, the surgical tool 13200 includes a tool mountingportion 13300 that includes a tool mounting plate 13302 that isconfigured to operably support the transmission arrangement 13305 and tomountingly interface with the adaptor portion 11240′ which is coupled tothe robotic system 11000 in the various manners described above. In atleast one embodiment, the adaptor portion 11240′ may be identical to theadaptor portion 11240 described in detail above without the powered discmembers employed by adapter 11240. In other embodiments, the adaptorportion 11240′ may be identical to adaptor portion 11240. However, insuch embodiments, because the various components of the surgical endeffector 13212 are all powered by motor(s) in the tool mounting portion13300, the surgical tool 13200 will not employ or require any of themechanical (i.e., non-electrical) actuation motions from the tool holderportion 11270 to power the surgical end effector 13200 components. Stillother modifications which are considered to be within the spirit andscope of the various forms of the present invention may employ one ormore of the mechanical motions from the tool holder portion 11270 (asdescribed hereinabove) to power/actuate one or more of the surgical endeffector components while also employing one or more motors within thetool mounting portion to power one or more other components of thesurgical end effector.

In various embodiments, the tool mounting plate 13302 is configured tosupport a first firing motor 13310 for supplying firing and retractionmotions to the transmission arrangement 13305 to drive a knife bar 13335that is coupled to a cutting instrument 13332 of the type describedabove. As can be seen in FIG. 137, the tool mounting plate 13212 has anarray of electrical connecting pins 13014 which are configured tointerface with the slots 11258 (FIG. 104) in the adapter 11240′. Sucharrangement permits the controller 11001 of the robotic system 11000 toprovide control signals to the electronic control circuits 13320, 13340of the surgical tool 13200. While the interface is described herein withreference to mechanical, electrical, and magnetic coupling elements, itshould be understood that a wide variety of telemetry modalities mightbe used, including infrared, inductive coupling, or the like.

In one form or embodiment, the first control circuit 13320 includes afirst power supply in the form of a first battery 13322 that is coupledto a first on-off solenoid powered switch 13324. The first firingcontrol circuit 13320 further includes a first on/off firing solenoid13326 that is coupled to a first double pole switch 13328 forcontrolling the rotational direction of the first firing motor 13310.Thus, when the robotic controller 11001 supplies an appropriate controlsignal, the first switch 13324 will permit the first battery 13322 tosupply power to the first double pole switch 13328. The roboticcontroller 11001 will also supply an appropriate signal to the firstdouble pole switch 13328 to supply power to the first firing motor13310. When it is desired to fire the surgical end effector (i.e., drivethe cutting instrument 13232 distally through tissue clamped in thesurgical end effector 13212, the first switch 13328 will be positionedin a first position by the robotic controller 11001. When it is desiredto retract the cutting instrument 13232 to the starting position, therobotic controller 11001 will send the appropriate control signal tomove the first switch 13328 to the second position.

Various embodiments of the surgical tool 13200 also employ a first gearbox 13330 that is sized, in cooperation with a firing drive gear 13332coupled thereto that operably interfaces with a firing gear train 13333.In at least one non-limiting embodiment, the firing gear train 13333comprises a firing driven gear 13334 that is in meshing engagement withdrive gear 13332, for generating a desired amount of driving forcenecessary to drive the cutting instrument 13232 through tissue and todrive and form staples in the various manners described herein. In theembodiment depicted in FIG. 137, the driven gear 13334 is coupled to adrive shaft 13335 that has a second driven gear 13336 coupled thereto.The second driven gear 13336 is supported in meshing engagement with athird driven gear 13337 that is in meshing engagement with a fourthdriven gear 13338. The fourth driven gear 13338 is in meshing engagementwith a threaded proximal portion 13339 of the knife bar 13235 that isconstrained to move axially. Thus, by rotating the drive shaft 13335 ina first direction, the cutting instrument 13232 is driven in the distaldirection “DD” and rotating the drive shaft 13335 in an opposite seconddirection, the cutting instrument 13232 may be retracted in the proximaldirection “PD”.

As indicated above, the opening and closing of the anvil 13224 iscontrolled by axially moving the elongated channel 13222 relative to theelongated shaft assembly 13208. The axial movement of the elongatedchannel 13222 is controlled by a closure control system 13339. Invarious embodiments, the closure control system 13339 includes a closureshaft 13340 which has a hollow threaded end portion 13341 thatthreadably engages a threaded closure rod 13342. The threaded endportion 13341 is rotatably supported in a spine shaft 13343 thatoperably interfaces with the tool mounting portion 13300 and extendsthrough a portion of the shaft assembly 13208 as shown. The closuresystem 13339 further comprises a closure control circuit 13350 thatincludes a second power supply in the form of a second battery 13352that is coupled to a second on-off solenoid powered switch 13354.Closure control circuit 13350 further includes a second on/off firingsolenoid 13356 that is coupled to a second double pole switch 13358 forcontrolling the rotation of a second closure motor 13360. Thus, when therobotic controller 11001 supplies an appropriate control signal, thesecond switch 13354 will permit the second battery 13352 to supply powerto the second double pole switch 13354. The robotic controller 11001will also supply an appropriate signal to the second double pole switch13358 to supply power to the second motor 13360. When it is desired toclose the anvil 13224, the second switch 13348 will be in a firstposition. When it is desired to open the anvil 13224, the second switch13348 will be moved to a second position.

Various embodiments of tool mounting portion 13300 also employ a secondgear box 13362 that is coupled to a closure drive gear 13364. Theclosure drive gear 13364 is in meshing engagement with a closure geartrain 13363. In various non-limiting forms, the closure gear train 13363includes a closure driven gear 13365 that is attached to a closure driveshaft 13366. Also attached to the closure drive shaft 13366 is a closuredrive gear 13367 that is in meshing engagement with a closure shaft gear13360 attached to the closure shaft 13340. FIG. 137 depicts the endeffector 13212 in the open position. As indicated above, when thethreaded closure rod 13342 is in the position depicted in FIG. 137, aspring (not shown) biases the anvil 13224 to the open position. When itis desired to close the anvil 13224, the robotic controller 11001 willactivate the second motor 13360 to rotate the closure shaft 13340 todraw the threaded closure rod 13342 and the channel 13222 in theproximal direction ‘PD’. As the anvil 13224 contacts the distal endportion 13209 of the shaft 13208, the anvil 13224 is pivoted to theclosed position.

A method of operating the surgical tool 13200 will now be described.Once the tool mounting portion 13302 has be operably coupled to the toolholder 11270 of the robotic system 11000, the robotic system 11000 canorient the end effector 13212 in position adjacent the target tissue tobe cut and stapled. If the anvil 13224 is not already in the openposition, the robotic controller 11001 may activate the second closuremotor 13360 to drive the channel 13222 in the distal direction to theposition depicted in FIG. 137. Once the robotic controller 11001determines that the surgical end effector 13212 is in the open positionby sensor(s) in the and effector and/or the tool mounting portion 13300,the robotic controller 11001 may provide the surgeon with a signal toinform the surgeon that the anvil 13224 may then be closed. Once thetarget tissue is positioned between the open anvil 13224 and thesurgical staple cartridge 13234, the surgeon may then commence theclosure process by activating the robotic controller 11001 to apply aclosure control signal to the second closure motor 13360. The secondclosure motor 13360 applies a rotary motion to the closure shaft 13340to draw the channel 13222 in the proximal direction “PD” until the anvil13224 has been pivoted to the closed position. Once the roboticcontroller 11001 determines that the anvil 13224 has been moved to theclosed position by sensor(s) in the surgical end effector 13212 and/orin the tool mounting portion 13300 that are in communication with therobotic control system, the motor 13360 may be deactivated. Thereafter,the firing process may be commenced either manually by the surgeonactivating a trigger, button, etc. on the controller 11001 or thecontroller 11001 may automatically commence the firing process.

To commence the firing process, the robotic controller 11001 activatesthe firing motor 13310 to drive the firing bar 13235 and the cuttinginstrument 13232 in the distal direction “DD”. Once robotic controller11001 has determined that the cutting instrument 13232 has moved to theending position within the surgical staple cartridge 13234 by means ofsensors in the surgical end effector 13212 and/or the motor driveportion 13300, the robotic controller 11001 may provide the surgeon withan indication signal. Thereafter the surgeon may manually activate thefirst motor 13310 to retract the cutting instrument 13232 to thestarting position or the robotic controller 11001 may automaticallyactivate the first motor 13310 to retract the cutting element 13232.

The embodiment depicted in FIG. 137 does not include an articulationjoint. FIGS. 138 and 139 illustrate surgical tools 13200′ and 13200″that have end effectors 13212′, 13212″, respectively that may beemployed with an elongated shaft embodiment that has an articulationjoint of the various types disclosed herein. For example, as can be seenin FIG. 138, a threaded closure shaft 13342 is coupled to the proximalend 13223 of the elongated channel 13222 by a flexible cable or otherflexible member 13345. The location of an articulation joint (not shown)within the elongated shaft assembly 13208 will coincide with theflexible member 13345 to enable the flexible member 13345 to accommodatesuch articulation. In addition, in the above-described embodiment, theflexible member 13345 is rotatably affixed to the proximal end portion13223 of the elongated channel 13222 to enable the flexible member 13345to rotate relative thereto to prevent the flexible member 13229 from“winding up” relative to the channel 13222. Although not shown, thecutting element may be driven in one of the above described manners by aknife bar that can also accommodate articulation of the elongated shaftassembly. FIG. 139 depicts a surgical end effector 13212″ that issubstantially identical to the surgical end effector 13212 describedabove, except that the threaded closure rod 13342 is attached to aclosure nut 13347 that is constrained to only move axially within theelongated shaft assembly 13208. The flexible member 13345 is attached tothe closure nut 13347. Such arrangement also prevents the threadedclosure rod 13342 from winding-up the flexible member 13345. A flexibleknife bar 13235′ may be employed to facilitate articulation of thesurgical end effector 13212″.

The surgical tools 13200, 13200′, and 13200″ described above may alsoemploy anyone of the cutting instrument embodiments described herein. Asdescribed above, the anvil of each of the end effectors of these toolsis closed by drawing the elongated channel into contact with the distalend of the elongated shaft assembly. Thus, once the target tissue hasbeen located between the staple cartridge 13234 and the anvil 13224, therobotic controller 11001 can start to draw the channel 13222 inward intothe shaft assembly 13208. In various embodiments, however, to preventthe end effector 13212, 13212′, 13212″ from moving the target tissuewith the end effector during this closing process, the controller 11001may simultaneously move the tool holder and ultimately the tool such tocompensate for the movement of the elongated channel 13222 so that, ineffect, the target tissue is clamped between the anvil and the elongatedchannel without being otherwise moved.

FIGS. 140-142 depict another surgical tool embodiment 13201 that issubstantially identical to surgical tool 13200″ described above, exceptfor the differences discussed below. In this embodiment, the threadedclosure rod 13342′ has variable pitched grooves. More specifically, ascan be seen in FIG. 141, the closure rod 13342′ has a distal groovesection 13380 and a proximal groove section 13382. The distal andproximal groove sections 13380, 13382 are configured for engagement witha lug 13390 supported within the hollow threaded end portion 13341′. Ascan be seen in FIG. 141, the distal groove section 13380 has a finerpitch than the groove section 13382. Thus, such variable pitcharrangement permits the elongated channel 13222 to be drawn into theshaft 13208 at a first speed or rate by virtue of the engagement betweenthe lug 13390 and the proximal groove segment 13382. When the lug 13390engages the distal groove segment, the channel 13222 will be drawn intothe shaft 13208 at a second speed or rate. Because the proximal groovesegment 13382 is coarser than the distal groove segment 13380, the firstspeed will be greater than the second speed. Such arrangement serves tospeed up the initial closing of the end effector for tissue manipulationand then after the tissue has been properly positioned therein, generatethe amount of closure forces to properly clamp the tissue for cuttingand sealing. Thus, the anvil 13234 initially closes fast with a lowerforce and then applies a higher closing force as the anvil closes moreslowly.

The surgical end effector opening and closing motions are employed toenable the user to use the end effector to grasp and manipulate tissueprior to fully clamping it in the desired location for cutting andsealing. The user may, for example, open and close the surgical endeffector numerous times during this process to orient the end effectorin a proper position which enables the tissue to be held in a desiredlocation. Thus, in at least some embodiments, to produce the highloading for firing, the fine thread may require as many as 5-10 fullrotations to generate the necessary load. In some cases, for example,this action could take as long as 2-5 seconds. If it also took anequally long time to open and close the end effector each time duringthe positioning/tissue manipulation process, just positioning the endeffector may take an undesirably long time. If that happens, it ispossible that a user may abandon such use of the end effector for use ofa conventional grasper device. Use of graspers, etc. may undesirablyincrease the costs associated with completing the surgical procedure.

The above-described embodiments employ a battery or batteries to powerthe motors used to drive the end effector components. Activation of themotors is controlled by the robotic system 11000. In alternativeembodiments, the power supply may comprise alternating current “AC” thatis supplied to the motors by the robotic system 11000. That is, the ACpower would be supplied from the system powering the robotic system11000 through the tool holder and adapter. In still other embodiments, apower cord or tether may be attached to the tool mounting portion 13300to supply the requisite power from a separate source of alternating ordirect current.

In use, the controller 11001 may apply an initial rotary motion to theclosure shaft 13340 (FIG. 137) to draw the elongated channel 13222axially inwardly into the elongated shaft assembly 13208 and move theanvil from a first position to an intermediate position at a first ratethat corresponds with the point wherein the distal groove section 13380transitions to the proximal groove section 13382. Further application ofrotary motion to the closure shaft 13340 will cause the anvil to movefrom the intermediate position to the closed position relative to thesurgical staple cartridge. When in the closed position, the tissue to becut and stapled is properly clamped between the anvil and the surgicalstaple cartridge.

FIGS. 143-147 illustrate another surgical tool embodiment 13400 of thepresent invention. This embodiment includes an elongated shaft assembly13408 that extends from a tool mounting portion 13500. The elongatedshaft assembly 13408 includes a rotatable proximal closure tube segment13410 that is rotatably journaled on a proximal spine member 13420 thatis rigidly coupled to a tool mounting plate 13502 of the tool mountingportion 13500. The proximal spine member 13420 has a distal end 13422that is coupled to an elongated channel portion 13522 of a surgical endeffector 13412. For example, in at least one embodiment, the elongatedchannel portion 13522 has a distal end portion 13523 that “hookinglyengages” the distal end 13422 of the spine member 13420. The elongatedchannel 13522 is configured to support a surgical staple cartridge 13534therein. This embodiment may employ one of the various cuttinginstrument embodiments disclosed herein to sever tissue that is clampedin the surgical end effector 13412 and fire the staples in the staplecartridge 13534 into the severed tissue.

Surgical end effector 13412 has an anvil 13524 that is pivotally coupledto the elongated channel 13522 by a pair of trunnions 13525 that arereceived in corresponding openings 13529 in the elongated channel 13522.The anvil 13524 is moved between the open (FIG. 143) and closedpositions (FIGS. 144-146) by a distal closure tube segment 13430. Adistal end portion 13432 of the distal closure tube segment 13430includes an opening 13445 into which a tab 13527 on the anvil 13524 isinserted in order to open and close the anvil 13524 as the distalclosure tube segment 13430 moves axially relative thereto. In variousembodiments, the opening 13445 is shaped such that as the closure tubesegment 13430 is moved in the proximal direction, the closure tubesegment 13430 causes the anvil 13524 to pivot to an open position. Inaddition or in the alternative, a spring (not shown) may be employed tobias the anvil 13524 to the open position.

As can be seen in FIGS. 143-146, the distal closure tube segment 13430includes a lug 13442 that extends from its distal end 13440 intothreaded engagement with a variable pitch groove/thread 13414 formed inthe distal end 13412 of the rotatable proximal closure tube segment13410. The variable pitch groove/thread 13414 has a distal section 13416and a proximal section 13418. The pitch of the distal groove/threadsection 13416 is finer than the pitch of the proximal groove/threadsection 13418. As can also be seen in FIGS. 143-146, the distal closuretube segment 13430 is constrained for axial movement relative to thespine member 13420 by an axial retainer pin 13450 that is received in anaxial slot 13424 in the distal end of the spine member 13420.

As indicated above, the anvil 12524 is open and closed by rotating theproximal closure tube segment 13410. The variable pitch threadarrangement permits the distal closure tube segment 13430 to be drivenin the distal direction “DD” at a first speed or rate by virtue of theengagement between the lug 13442 and the proximal groove/thread section13418. When the lug 13442 engages the distal groove/thread section13416, the distal closure tube segment 13430 will be driven in thedistal direction at a second speed or rate. Because the proximalgroove/thread section 13418 is coarser than the distal groove/threadsegment 13416, the first speed will be greater than the second speed.

In at least one embodiment, the tool mounting portion 13500 isconfigured to receive a corresponding first rotary motion from therobotic controller 11001 and convert that first rotary motion to aprimary rotary motion for rotating the rotatable proximal closure tubesegment 13410 about a longitudinal tool axis LT-LT. As can be seen inFIG. 147, a proximal end 13460 of the proximal closure tube segment13410 is rotatably supported within a cradle arrangement 13504 attachedto a tool mounting plate 13502 of the tool mounting portion 13500. Arotation gear 13462 is formed on or attached to the proximal end 13460of the closure tube segment 13410 for meshing engagement with a rotationdrive assembly 13470 that is operably supported on the tool mountingplate 13502. In at least one embodiment, a rotation drive gear 13472 iscoupled to a corresponding first one of the driven discs or elements11304 on the adapter side of the tool mounting plate 13502 when the toolmounting portion 13500 is coupled to the tool holder 11270. See FIGS.105 and 146. The rotation drive assembly 13470 further comprises arotary driven gear 13474 that is rotatably supported on the toolmounting plate 13502 in meshing engagement with the rotation gear 13462and the rotation drive gear 13472. Application of a first rotary controlmotion from the robotic controller 11001 through the tool holder 11270and the adapter 11240 to the corresponding driven element 11304 willthereby cause rotation of the rotation drive gear 13472 by virtue ofbeing operably coupled thereto. Rotation of the rotation drive gear13472 ultimately results in the rotation of the closure tube segment13410 to open and close the anvil 13524 as described above.

As indicated above, the surgical end effector 13412 employs a cuttinginstrument of the type and constructions described above. FIG. 147illustrates one form of knife drive assembly 13480 for axially advancinga knife bar 13492 that is attached to such cutting instrument. One formof the knife drive assembly 13480 comprises a rotary drive gear 13482that is coupled to a corresponding third one of the driven discs orelements 11304 on the adapter side of the tool mounting plate 13502 whenthe tool drive portion 13500 is coupled to the tool holder 11270. SeeFIGS. 105 and 147. The knife drive assembly 13480 further comprises afirst rotary driven gear assembly 13484 that is rotatably supported onthe tool mounting plate 15200. The first rotary driven gear assembly13484 is in meshing engagement with a third rotary driven gear assembly13486 that is rotatably supported on the tool mounting plate 13502 andwhich is in meshing engagement with a fourth rotary driven gear assembly13488 that is in meshing engagement with a threaded portion 13494 ofdrive shaft assembly 13490 that is coupled to the knife bar 13492.Rotation of the rotary drive gear 13482 in a second rotary directionwill result in the axial advancement of the drive shaft assembly 13490and knife bar 13492 in the distal direction “DD”. Conversely, rotationof the rotary drive gear 13482 in a secondary rotary direction (oppositeto the second rotary direction) will cause the drive shaft assembly13490 and the knife bar 13492 to move in the proximal direction.

FIGS. 148-157 illustrate another surgical tool 13600 embodiment of thepresent invention that may be employed in connection with a roboticsystem 11000. As can be seen in FIG. 148, the tool 13600 includes an endeffector in the form of a disposable loading unit 13612. Various formsof disposable loading units that may be employed in connection with tool13600 are disclosed, for example, in U.S. Patent Application PublicationNo. US 2009/0206131 A1, entitled “End Effector Arrangements For aSurgical Cutting and Stapling Instrument”, the disclosure of which isherein incorporated by reference in its entirety.

In at least one form, the disposable loading unit 13612 includes ananvil assembly 13620 that is supported for pivotal travel relative to acarrier 13630 that operably supports a staple cartridge 13640 therein. Amounting assembly 13650 is pivotally coupled to the cartridge carrier13630 to enable the carrier 13630 to pivot about an articulation axisAA-AA relative to a longitudinal tool axis LT-LT. Referring to FIG. 153,mounting assembly 13650 includes upper and lower mounting portions 13652and 13654. Each mounting portion includes a threaded bore 13656 on eachside thereof dimensioned to receive threaded bolts (not shown) forsecuring the proximal end of carrier 13630 thereto. A pair of centrallylocated pivot members 13658 extends between upper and lower mountingportions via a pair of coupling members 13660 which engage a distal endof a housing portion 13662. Coupling members 13660 each include aninterlocking proximal portion 13664 configured to be received in grooves13666 formed in the proximal end of housing portion 13662 to retainmounting assembly 13650 and housing portion 13662 in a longitudinallyfixed position in relation thereto.

In various forms, housing portion 13662 of disposable loading unit 13614includes an upper housing half 13670 and a lower housing half 13672contained within an outer casing 13674. The proximal end of housing half13670 includes engagement nubs 13676 for releasably engaging anelongated shaft 13700 and an insertion tip 13678. Nubs 13676 form abayonet-type coupling with the distal end of the elongated shaft 13700which will be discussed in further detail below. Housing halves 13670,13672 define a channel 13675 for slidably receiving axial drive assembly13680. A second articulation link 13690 is dimensioned to be slidablypositioned within a slot 13679 formed between housing halves 13670,13672. A pair of blow out plates 13691 are positioned adjacent thedistal end of housing portion 13662 adjacent the distal end of axialdrive assembly 13680 to prevent outward bulging of drive assembly 13680during articulation of carrier 13630.

In various embodiments, the second articulation link 13690 includes atleast one elongated metallic plate. Preferably, two or more metallicplates are stacked to form link 13690. The proximal end of articulationlink 13690 includes a hook portion 13692 configured to engage firstarticulation link 13710 extending through the elongated shaft 13700. Thedistal end of the second articulation link 13690 includes a loop 13694dimensioned to engage a projection formed on mounting assembly 13650.The projection is laterally offset from pivot pin 13658 such that linearmovement of second articulation link 13690 causes mounting assembly13650 to pivot about pivot pins 13658 to articulate the carrier 13630.

In various forms, axial drive assembly 13680 includes an elongated drivebeam 13682 including a distal working head 13684 and a proximalengagement section 13685. Drive beam 13682 may be constructed from asingle sheet of material or, preferably, multiple stacked sheets.Engagement section 13685 includes a pair of engagement fingers which aredimensioned and configured to mountingly engage a pair of correspondingretention slots formed in drive member 13686. Drive member 13686includes a proximal porthole 13687 configured to receive the distal end13722 of control rod 12720 (See FIG. 157) when the proximal end ofdisposable loading unit 13614 is engaged with elongated shaft 13700 ofsurgical tool 13600.

Referring to FIGS. 148 and 155-157, to use the surgical tool 13600, adisposable loading unit 13612 is first secured to the distal end ofelongated shaft 13700. It will be appreciated that the surgical tool13600 may include an articulating or a non-articulating disposableloading unit. To secure the disposable loading unit 13612 to theelongated shaft 13700, the distal end 13722 of control rod 13720 isinserted into insertion tip 13678 of disposable loading unit 13612, andinsertion tip 13678 is slid longitudinally into the distal end of theelongated shaft 13700 in the direction indicated by arrow “A” in FIG.155 such that hook portion 13692 of second articulation link 13690slides within a channel 13702 in the elongated shaft 13700. Nubs 13676will each be aligned in a respective channel (not shown) in elongatedshaft 13700. When hook portion 13692 engages the proximal wall 13704 ofchannel 13702, disposable loading unit 13612 is rotated in the directionindicated by arrow “B” in FIGS. 154 and 157 to move hook portion 13692of second articulation link 13690 into engagement with finger 13712 offirst articulation link 13710. Nubs 13676 also form a “bayonet-type”coupling within annular channel 13703 in the elongated shaft 13700.During rotation of loading unit 13612, nubs 13676 engage cam surface13732 (FIG. 155) of block plate 13730 to initially move plate 13730 inthe direction indicated by arrow “C” in FIG. 155 to lock engagementmember 13734 in recess 13721 of control rod 13720 to preventlongitudinal movement of control rod 13720 during attachment ofdisposable loading unit 13612. During the final degree of rotation, nubs13676 disengage from cam surface 13732 to allow blocking plate 13730 tomove in the direction indicated by arrow “D” in FIGS. 154 and 157 frombehind engagement member 13734 to once again permit longitudinalmovement of control rod 13720. While the above-described attachmentmethod reflects that the disposable loading unit 13612 is manipulatedrelative to the elongated shaft 13700, the person of ordinary skill inthe art will appreciate that the disposable loading unit 13612 may besupported in a stationary position and the robotic system 11000 maymanipulate the elongated shaft portion 13700 relative to the disposableloading unit 13612 to accomplish the above-described coupling procedure.

FIG. 158 illustrates another disposable loading unit 13612′ that isattachable in a bayonet-type arrangement with the elongated shaft 13700′that is substantially identical to shaft 13700 except for thedifferences discussed below. As can be seen in FIG. 158, the elongatedshaft 13700′ has slots 13705 that extend for at least a portion thereofand which are configured to receive nubs 13676 therein. In variousembodiments, the disposable loading unit 13612′ includes arms 13677extending therefrom which, prior to the rotation of disposable loadingunit 13612′, can be aligned, or at least substantially aligned, withnubs 13676 extending from housing portion 13662. In at least oneembodiment, arms 13677 and nubs 13676 can be inserted into slots 13705in elongated shaft 13700′, for example, when disposable loading unit13612′ is inserted into elongated shaft 13700′. When disposable loadingunit 13612′ is rotated, arms 13677 can be sufficiently confined withinslots 13705 such that slots 13705 can hold them in position, whereasnubs 13676 can be positioned such that they are not confined withinslots 13705 and can be rotated relative to arms 13677. When rotated, thehook portion 13692 of the articulation link 13690 is engaged with thefirst articulation link 13710 extending through the elongated shaft13700′.

Other methods of coupling the disposable loading units to the end of theelongated shaft may be employed. For example, as shown in FIGS. 159 and160, disposable loading unit 13612″ can include connector portion 13613which can be configured to be engaged with connector portion 13740 ofthe elongated shaft 13700″. In at least one embodiment, connectorportion 13613 can include at least one projection and/or groove whichcan be mated with at least one projection and/or groove of connectorportion 13740. In at least one such embodiment, the connector portionscan include co-operating dovetail portions. In various embodiments, theconnector portions can be configured to interlock with one another andprevent, or at least inhibit, distal and/or proximal movement ofdisposable loading unit 13612″ along axis 13741. In at least oneembodiment, the distal end of the axial drive assembly 13680′ caninclude aperture 13681 which can be configured to receive projection13721 extending from control rod 13720′. In various embodiments, such anarrangement can allow disposable loading unit 13612″ to be assembled toelongated shaft 13700 in a direction which is not collinear with orparallel to axis 13741. Although not illustrated, axial drive assembly13680′ and control rod 13720 can include any other suitable arrangementof projections and apertures to operably connect them to each other.Also in this embodiment, the first articulation link 13710 which can beoperably engaged with second articulation link 13690.

As can be seen in FIGS. 148 and 161, the surgical tool 13600 includes atool mounting portion 13750. The tool mounting portion 13750 includes atool mounting plate 13751 that is configured for attachment to the tooldrive assembly 11010. The tool mounting portion operably supported atransmission arrangement 13752 thereon. In use, it may be desirable torotate the disposable loading unit 13612 about the longitudinal toolaxis defined by the elongated shaft 13700. In at least one embodiment,the transmission arrangement 13752 includes a rotational transmissionassembly 13753 that is configured to receive a corresponding rotaryoutput motion from the tool drive assembly 11010 of the robotic system11000 and convert that rotary output motion to a rotary control motionfor rotating the elongated shaft 13700 (and the disposable loading unit13612) about the longitudinal tool axis LT-LT. As can be seen in FIG.161, a proximal end 13701 of the elongated shaft 13700 is rotatablysupported within a cradle arrangement 13754 that is attached to the toolmounting plate 13751 of the tool mounting portion 13750. A rotation gear13755 is formed on or attached to the proximal end 13701 of theelongated shaft 13700 for meshing engagement with a rotation gearassembly 13756 operably supported on the tool mounting plate 13751. Inat least one embodiment, a rotation drive gear 13757 drivingly coupledto a corresponding first one of the driven discs or elements 11304 onthe adapter side of the tool mounting plate 13751 when the tool mountingportion 13750 is coupled to the tool drive assembly 11010. The rotationtransmission assembly 13753 further comprises a rotary driven gear 13758that is rotatably supported on the tool mounting plate 13751 in meshingengagement with the rotation gear 13755 and the rotation drive gear13757. Application of a first rotary output motion from the roboticsystem 11000 through the tool drive assembly 11010 to the correspondingdriven element 11304 will thereby cause rotation of the rotation drivegear 13757 by virtue of being operably coupled thereto. Rotation of therotation drive gear 13757 ultimately results in the rotation of theelongated shaft 13700 (and the disposable loading unit 13612) about thelongitudinal tool axis LT-LT (primary rotary motion).

As can be seen in FIG. 161, a drive shaft assembly 13760 is coupled to aproximal end of the control rod 12720. In various embodiments, thecontrol rod 12720 is axially advanced in the distal and proximaldirections by a knife/closure drive transmission 13762. One form of theknife/closure drive assembly 13762 comprises a rotary drive gear 13763that is coupled to a corresponding second one of the driven rotatablebody portions, discs or elements 11304 on the adapter side of the toolmounting plate 13751 when the tool mounting portion 13750 is coupled tothe tool holder 11270. The rotary driven gear 13763 is in meshingdriving engagement with a gear train, generally depicted as 13764. In atleast one form, the gear train 13764 further comprises a first rotarydriven gear assembly 13765 that is rotatably supported on the toolmounting plate 13751. The first rotary driven gear assembly 13765 is inmeshing engagement with a second rotary driven gear assembly 13766 thatis rotatably supported on the tool mounting plate 13751 and which is inmeshing engagement with a third rotary driven gear assembly 13767 thatis in meshing engagement with a threaded portion 13768 of the driveshaft assembly 13760. Rotation of the rotary drive gear 13763 in asecond rotary direction will result in the axial advancement of thedrive shaft assembly 13760 and control rod 12720 in the distal direction“DD”. Conversely, rotation of the rotary drive gear 13763 in a secondaryrotary direction which is opposite to the second rotary direction willcause the drive shaft assembly 13760 and the control rod 12720 to movein the proximal direction. When the control rod 12720 moves in thedistal direction, it drives the drive beam 13682 and the working head13684 thereof distally through the surgical staple cartridge 13640. Asthe working head 13684 is driven distally, it operably engages the anvil13620 to pivot it to a closed position.

The cartridge carrier 13630 may be selectively articulated aboutarticulation axis AA-AA by applying axial articulation control motionsto the first and second articulation links 13710 and 13690. In variousembodiments, the transmission arrangement 13752 further includes anarticulation drive 13770 that is operably supported on the tool mountingplate 13751. More specifically and with reference to FIG. 161, it can beseen that a proximal end portion 13772 of an articulation drive shaft13771 configured to operably engage with the first articulation link13710 extends through the rotation gear 13755 and is rotatably coupledto a shifter rack gear 13774 that is slidably affixed to the toolmounting plate 13751 through slots 13775. The articulation drive 13770further comprises a shifter drive gear 13776 that is coupled to acorresponding third one of the driven discs or elements 11304 on theadapter side of the tool mounting plate 13751 when the tool mountingportion 13750 is coupled to the tool holder 11270. The articulationdrive assembly 13770 further comprises a shifter driven gear 13778 thatis rotatably supported on the tool mounting plate 13751 in meshingengagement with the shifter drive gear 13776 and the shifter rack gear13774. Application of a third rotary output motion from the roboticsystem 11000 through the tool drive assembly 11010 to the correspondingdriven element 11304 will thereby cause rotation of the shifter drivegear 13776 by virtue of being operably coupled thereto. Rotation of theshifter drive gear 13776 ultimately results in the axial movement of theshifter gear rack 13774 and the articulation drive shaft 13771. Thedirection of axial travel of the articulation drive shaft 13771 dependsupon the direction in which the shifter drive gear 13776 is rotated bythe robotic system 11000. Thus, rotation of the shifter drive gear 13776in a first rotary direction will result in the axial movement of thearticulation drive shaft 13771 in the proximal direction “PD” and causethe cartridge carrier 13630 to pivot in a first direction aboutarticulation axis AA-AA. Conversely, rotation of the shifter drive gear13776 in a second rotary direction (opposite to the first rotarydirection) will result in the axial movement of the articulation driveshaft 13771 in the distal direction “DD” to thereby cause the cartridgecarrier 13630 to pivot about articulation axis AA-AA in an oppositedirection.

FIG. 162 illustrates yet another surgical tool 13800 embodiment of thepresent invention that may be employed with a robotic system 11000. Ascan be seen in FIG. 162, the surgical tool 13800 includes a surgical endeffector 13812 in the form of an endocutter 13814 that employs variouscable-driven components. Various forms of cable driven endocutters aredisclosed, for example, in U.S. Pat. No. 7,726,537, entitled “SurgicalStapler With Universal Articulation and Tissue Pre-Clamp” and U.S.Patent Application Publication No. US 2008/0308603A1, entitled “CableDriven Surgical Stapling and Cutting Instrument With Improved CableAttachment Arrangements”, the disclosures of each are hereinincorporated by reference in their respective entireties. Suchendocutters 13814 may be referred to as a “disposable loading unit”because they are designed to be disposed of after a single use. However,the various unique and novel arrangements of various embodiments of thepresent invention may also be employed in connection with cable drivenend effectors that are reusable.

As can be seen in FIG. 163, in at least one form, the endocutter 13814includes an elongated channel 13822 that operably supports a surgicalstaple cartridge 13834 therein. An anvil 13824 is pivotally supportedfor movement relative to the surgical staple cartridge 13834. The anvil13824 has a cam surface 13825 that is configured for interaction with apreclamping collar 13840 that is supported for axial movement relativethereto. The end effector 13814 is coupled to an elongated shaftassembly 13808 that is attached to a tool mounting portion 13900. Invarious embodiments, a closure cable 13850 is employed to movepre-clamping collar 13840 distally onto and over cam surface 13825 toclose the anvil 13824 relative to the surgical staple cartridge 13834and compress the tissue therebetween. Preferably, closure cable 13850attaches to the pre-clamping collar 13840 at or near point 13841 and isfed through a passageway in anvil 13824 (or under a proximal portion ofanvil 13824) and fed proximally through shaft 13808. Actuation ofclosure cable 13850 in the proximal direction “PD” forces pre-clampingcollar 13840 distally against cam surface 13825 to close anvil 13824relative to staple cartridge assembly 13834. A return mechanism, e.g., aspring, cable system or the like, may be employed to return pre-clampingcollar 13840 to a pre-clamping orientation which re-opens the anvil13824.

The elongated shaft assembly 13808 may be cylindrical in shape anddefine a channel 13811 which may be dimensioned to receive a tubeadapter 13870. See FIG. 163. In various embodiments, the tube adapter13870 may be slidingly received in friction-fit engagement with theinternal channel of elongated shaft 13808. The outer surface of the tubeadapter 13870 may further include at least one mechanical interface,e.g., a cutout or notch 13871, oriented to mate with a correspondingmechanical interface, e.g., a radially inwardly extending protrusion ordetent (not shown), disposed on the inner periphery of internal channel13811 to lock the tube adapter 13870 to the elongated shaft 13808. Invarious embodiments, the distal end of tube adapter 13870 may include apair of opposing flanges 13872 a and 13872 b which define a cavity forpivotably receiving a pivot block 13873 therein. Each flange 13872 a and13872 b may include an aperture 13874 a and 13874 b that is oriented toreceive a pivot pin 13875 that extends through an aperture in pivotblock 13873 to allow pivotable movement of pivot block 13873 about anaxis that is perpendicular to longitudinal tool axis “LT-LT”. Thechannel 13822 may be formed with two upwardly extending flanges 13823 a,13823 b that have apertures therein, which are dimensioned to receive apivot pin 13827. In turn, pivot pin 13875 mounts through apertures inpivot block 13873 to permit rotation of the surgical end effector 13814about the “Y” axis as needed during a given surgical procedure. Rotationof pivot block 13873 about pin 13875 along “Z” axis rotates the surgicalend effector 13814 about the “Z” axis. See FIG. 163. Other methods offastening the elongated channel 13822 to the pivot block 13873 may beeffectively employed without departing from the spirit and scope of thepresent invention.

The surgical staple cartridge 13834 can be assembled and mounted withinthe elongated channel 13822 during the manufacturing or assembly processand sold as part of the surgical end effector 13812, or the surgicalstaple cartridge 13834 may be designed for selective mounting within theelongated channel 13822 as needed and sold separately, e.g., as a singleuse replacement, replaceable or disposable staple cartridge assembly. Itis within the scope of this disclosure that the surgical end effector13812 may be pivotally, operatively, or integrally attached, forexample, to distal end 13809 of the elongated shaft assembly 13808 of adisposable surgical stapler. As is known, a used or spent disposableloading unit 13814 can be removed from the elongated shaft assembly13808 and replaced with an unused disposable unit. The endocutter 13814may also preferably include an actuator, preferably a dynamic clampingmember 13860, a sled 13862, as well as staple pushers (not shown) andstaples (not shown) once an unspent or unused cartridge 13834 is mountedin the elongated channel 13822. See FIG. 163.

In various embodiments, the dynamic clamping member 13860 is associatedwith, e.g., mounted on and rides on, or with or is connected to orintegral with and/or rides behind sled 13862. It is envisioned thatdynamic clamping member 13860 can have cam wedges or cam surfacesattached or integrally formed or be pushed by a leading distal surfacethereof. In various embodiments, dynamic clamping member 13860 mayinclude an upper portion 13863 having a transverse aperture 13864 with apin 13865 mountable or mounted therein, a central support or upwardextension 13866 and substantially T-shaped bottom flange 13867 whichcooperate to slidingly retain dynamic clamping member 13860 along anideal cutting path during longitudinal, distal movement of sled 13862.The leading cutting edge 13868, here, knife blade 13869, is dimensionedto ride within slot 13835 of staple cartridge assembly 13834 andseparate tissue once stapled. As used herein, the term “knife assembly”may include the aforementioned dynamic clamping member 13860, knife13869, and sled 13862 or other knife/beam/sled drive arrangements andcutting instrument arrangements. In addition, the various embodiments ofthe present invention may be employed with knife assembly/cuttinginstrument arrangements that may be entirely supported in the staplecartridge 13834 or partially supported in the staple cartridge 13834 andelongated channel 13822 or entirely supported within the elongatedchannel 13822.

In various embodiments, the dynamic clamping member 13860 may be drivenin the proximal and distal directions by a cable drive assembly 13870.In one non-limiting form, the cable drive assembly comprises a pair ofadvance cables 13880, 13882 and a firing cable 13884. FIGS. 164 and 165illustrate the cables 13880, 13882, 13884 in diagrammatic form. As canbe seen in those Figures, a first advance cable 13880 is operablysupported on a first distal cable transition support 13885 which maycomprise, for example, a pulley, rod, capstan, etc. that is attached tothe distal end of the elongated channel 13822 and a first proximal cabletransition support 13886 which may comprise, for example, a pulley, rod,capstan, etc. that is operably supported by the elongated channel 13822.A distal end 13881 of the first advance cable 13880 is affixed to thedynamic clamping assembly 13860. The second advance cable 13882 isoperably supported on a second distal cable transition support 13887which may, for example, comprise a pulley, rod, capstan etc. that ismounted to the distal end of the elongated channel 13822 and a secondproximal cable transition support 13888 which may, for example, comprisea pulley, rod, capstan, etc. mounted to the proximal end of theelongated channel 13822. The proximal end 13883 of the second advancecable 13882 may be attached to the dynamic clamping assembly 13860. Alsoin these embodiments, an endless firing cable 13884 is employed andjournaled on a support 13889 that may comprise a pulley, rod, capstan,etc. mounted within the elongated shaft 13808. In one embodiment, theretract cable 13884 may be formed in a loop and coupled to a connector13889′ that is fixedly attached to the first and second advance cables13880, 13882.

Various non-limiting embodiments of the present invention include acable drive transmission 13920 that is operably supported on a toolmounting plate 13902 of the tool mounting portion 13900. The toolmounting portion 13900 has an array of electrical connecting pins 13904which are configured to interface with the slots 11258 (FIG. 104) in theadapter 11240′. Such arrangement permits the robotic system 11000 toprovide control signals to a control circuit 13910 of the tool 13800.While the interface is described herein with reference to mechanical,electrical, and magnetic coupling elements, it should be understood thata wide variety of telemetry modalities might be used, includinginfrared, inductive coupling, or the like.

Control circuit 13910 is shown in schematic form in FIG. 162. In oneform or embodiment, the control circuit 13910 includes a power supply inthe form of a battery 13912 that is coupled to an on-off solenoidpowered switch 13914. In other embodiments, however, the power supplymay comprise a source of alternating current. Control circuit 13910further includes an on/off solenoid 13916 that is coupled to a doublepole switch 13918 for controlling motor rotation direction. Thus, whenthe robotic system 11000 supplies an appropriate control signal, switch13914 will permit battery 13912 to supply power to the double poleswitch 13918. The robotic system 11000 will also supply an appropriatesignal to the double pole switch 13918 to supply power to a shiftermotor 13922.

Turning to FIGS. 166-171, at least one embodiment of the cable drivetransmission 13920 comprises a drive pulley 13930 that is operablymounted to a drive shaft 13932 that is attached to a driven element11304 of the type and construction described above that is designed tointerface with a corresponding drive element 11250 of the adapter 11240.See FIGS. 104 and 169. Thus, when the tool mounting portion 13900 isoperably coupled to the tool holder 11270, the robot system 11000 canapply rotary motion to the drive pulley 13930 in a desired direction. Afirst drive member or belt 13934 drivingly engages the drive pulley13930 and a second drive shaft 13936 that is rotatably supported on ashifter yoke 13940. The shifter yoke 13940 is operably coupled to theshifter motor 13922 such that rotation of the shaft 13923 of the shiftermotor 13922 in a first direction will shift the shifter yoke in a firstdirection “FD” and rotation of the shifter motor shaft 13923 in a seconddirection will shift the shifter yoke 13940 in a second direction “SD”.Other embodiments of the present invention may employ a shifter solenoidarrangement for shifting the shifter yoke in said first and seconddirections.

As can be seen in FIGS. 166-169, a closure drive gear 13950 mounted to asecond drive shaft 13936 and is configured to selectively mesh with aclosure drive assembly, generally designated as 13951. Likewise a firingdrive gear 13960 is also mounted to the second drive shaft 13936 and isconfigured to selectively mesh with a firing drive assembly generallydesignated as 13961. Rotation of the second drive shaft 13936 causes theclosure drive gear 13950 and the firing drive gear 13960 to rotate. Inone non-limiting embodiment, the closure drive assembly 13951 comprisesa closure driven gear 13952 that is coupled to a first closure pulley13954 that is rotatably supported on a third drive shaft 13956. Theclosure cable 13850 is drivingly received on the first closure pulley13954 such that rotation of the closure driven gear 13952 will drive theclosure cable 13850. Likewise, the firing drive assembly 13961 comprisesa firing driven gear 13962 that is coupled to a first firing pulley13964 that is rotatably supported on the third drive shaft 13956. Thefirst and second driving pulleys 13954 and 13964 are independentlyrotatable on the third drive shaft 13956. The firing cable 13884 isdrivingly received on the first firing pulley 13964 such that rotationof the firing driven gear 13962 will drive the firing cable 13884.

Also in various embodiments, the cable drive transmission 13920 furtherincludes a braking assembly 13970. In at least one embodiment, forexample, the braking assembly 13970 includes a closure brake 13972 thatcomprises a spring arm 13973 that is attached to a portion of thetransmission housing 13971. The closure brake 13972 has a gear lug 13974that is sized to engage the teeth of the closure driven gear 13952 aswill be discussed in further detail below. The braking assembly 13970further includes a firing brake 13976 that comprises a spring arm 13977that is attached to another portion of the transmission housing 13971.The firing brake 13976 has a gear lug 13978 that is sized to engage theteeth of the firing driven gear 13962.

At least one embodiment of the surgical tool 13800 may be used asfollows. The tool mounting portion 13900 is operably coupled to theinterface 11240 of the robotic system 11000. The controller or controlunit of the robotic system is operated to locate the tissue to be cutand stapled between the open anvil 13824 and the staple cartridge 13834.When in that initial position, the braking assembly 13970 has locked theclosure driven gear 13952 and the firing driven gear 13962 such thatthey cannot rotate. That is, as shown in FIG. 167, the gear lug 13974 isin locking engagement with the closure driven gear 13952 and the gearlug 13978 is in locking engagement with the firing driven gear 13962.Once the surgical end effector 13814 has been properly located, thecontroller 11001 of the robotic system 11000 will provide a controlsignal to the shifter motor 13922 (or shifter solenoid) to move theshifter yoke 13940 in the first direction. As the shifter yoke 13940 ismoved in the first direction, the closure drive gear 13950 moves thegear lug 13974 out of engagement with the closure driven gear 13952 asit moves into meshing engagement with the closure driven gear 13952. Ascan be seen in FIG. 166, when in that position, the gear lug 13978remains in locking engagement with the firing driven gear 13962 toprevent actuation of the firing system. Thereafter, the roboticcontroller 11001 provides a first rotary actuation motion to the drivepulley 13930 through the interface between the driven element 11304 andthe corresponding components of the tool holder 11240. As the drivepulley 13930 is rotated in the first direction, the closure cable 13850is rotated to drive the preclamping collar 13840 into closing engagementwith the cam surface 13825 of the anvil 13824 to move it to the closedposition thereby clamping the target tissue between the anvil 13824 andthe staple cartridge 13834. See FIG. 162. Once the anvil 13824 has beenmoved to the closed position, the robotic controller 11001 stops theapplication of the first rotary motion to the drive pulley 13930.Thereafter, the robotic controller 11001 may commence the firing processby sending another control signal to the shifter motor 13922 (or shiftersolenoid) to cause the shifter yoke to move in the second direction “SD”as shown in FIG. 168. As the shifter yoke 13940 is moved in the seconddirection, the firing drive gear 13960 moves the gear lug 13978 out ofengagement with the firing driven gear 13962 as it moves into meshingengagement with the firing driven gear 13962. As can be seen in FIG.168, when in that position, the gear lug 13974 remains in lockingengagement with the closure driven gear 13952 to prevent actuation ofthe closure system. Thereafter, the robotic controller 11001 isactivated to provide the first rotary actuation motion to the drivepulley 13930 through the interface between the driven element 11304 andthe corresponding components of the tool holder 11240. As the drivepulley 13930 is rotated in the first direction, the firing cable 13884is rotated to drive the dynamic clamping member 13860 in the distaldirection “DD” thereby firing the stapes and cutting the tissue clampedin the end effector 13814. Once the robotic system 11000 determines thatthe dynamic clamping member 13860 has reached its distal mostposition—either through sensors or through monitoring the amount ofrotary input applied to the drive pulley 13930, the controller 11001 maythen apply a second rotary motion to the drive pulley 13930 to rotatethe closure cable 13850 in an opposite direction to cause the dynamicclamping member 13860 to be retracted in the proximal direction “PD”.Once the dynamic clamping member has been retracted to the startingposition, the application of the second rotary motion to the drivepulley 13930 is discontinued. Thereafter, the shifter motor 13922 (orshifter solenoid) is powered to move the shifter yoke 13940 to theclosure position (FIG. 166). Once the closure drive gear 13950 is inmeshing engagement with the closure driven gear 13952, the roboticcontroller 11001 may once again apply the second rotary motion to thedrive pulley 13930. Rotation of the drive pulley 13930 in the seconddirection causes the closure cable 13850 to retract the preclampingcollar 13840 out of engagement with the cam surface 13825 of the anvil13824 to permit the anvil 13824 to move to an open position (by a springor other means) to release the stapled tissue from the surgical endeffector 13814.

FIG. 172 illustrates a surgical tool 14000 that employs a gear drivenfiring bar 14092 as shown in FIGS. 173-175. This embodiment includes anelongated shaft assembly 14008 that extends from a tool mounting portion14100. The tool mounting portion 14100 includes a tool mounting plate14102 that operable supports a transmission arrangement 14103 thereon.The elongated shaft assembly 14008 includes a rotatable proximal closuretube 14010 that is rotatably journaled on a proximal spine member 14020that is rigidly coupled to the tool mounting plate 14102. The proximalspine member 14020 has a distal end that is coupled to an elongatedchannel portion 14022 of a surgical end effector 14012. The surgicaleffector 14012 may be substantially similar to surgical end effector13412 described above. In addition, the anvil 14024 of the surgical endeffector 14012 may be opened and closed by a distal closure tube 14030that operably interfaces with the proximal closure tube 14010. Distalclosure tube 14030 is identical to distal closure tube 13430 describedabove. Similarly, proximal closure tube 14010 is identical to proximalclosure tube segment 13410 described above.

Anvil 14024 is opened and closed by rotating the proximal closure tube14010 in manner described above with respect to distal closure tube13410. In at least one embodiment, the transmission arrangementcomprises a closure transmission, generally designated as 14011. As willbe further discussed below, the closure transmission 14011 is configuredto receive a corresponding first rotary motion from the robotic system11000 and convert that first rotary motion to a primary rotary motionfor rotating the rotatable proximal closure tube 14010 about thelongitudinal tool axis LT-LT. As can be seen in FIG. 175, a proximal end14060 of the proximal closure tube 14010 is rotatably supported within acradle arrangement 14104 that is attached to a tool mounting plate 14102of the tool mounting portion 14100. A rotation gear 14062 is formed onor attached to the proximal end 14060 of the closure tube segment 14010for meshing engagement with a rotation drive assembly 14070 that isoperably supported on the tool mounting plate 14102. In at least oneembodiment, a rotation drive gear 14072 is coupled to a correspondingfirst one of the driven discs or elements 11304 on the adapter side ofthe tool mounting plate 14102 when the tool mounting portion 14100 iscoupled to the tool holder 11270. See FIGS. 105 and 175. The rotationdrive assembly 14070 further comprises a rotary driven gear 14074 thatis rotatably supported on the tool mounting plate 14102 in meshingengagement with the rotation gear 14062 and the rotation drive gear14072. Application of a first rotary control motion from the roboticsystem 11000 through the tool holder 11270 and the adapter 11240 to thecorresponding driven element 11304 will thereby cause rotation of therotation drive gear 14072 by virtue of being operably coupled thereto.Rotation of the rotation drive gear 14072 ultimately results in therotation of the closure tube segment 14010 to open and close the anvil14024 as described above.

As indicated above, the end effector 14012 employs a cutting element13860 as shown in FIGS. 173 and 174. In at least one non-limitingembodiment, the transmission arrangement 14103 further comprises a knifedrive transmission that includes a knife drive assembly 14080. FIG. 175illustrates one form of knife drive assembly 14080 for axially advancingthe knife bar 14092 that is attached to such cutting element usingcables as described above with respect to surgical tool 13800. Inparticular, the knife bar 14092 replaces the firing cable 13884 employedin an embodiment of surgical tool 13800. One form of the knife driveassembly 14080 comprises a rotary drive gear 14082 that is coupled to acorresponding second one of the driven discs or elements 11304 on theadapter side of the tool mounting plate 14102 when the tool mountingportion 14100 is coupled to the tool holder 11270. See FIGS. 105 and175. The knife drive assembly 14080 further comprises a first rotarydriven gear assembly 14084 that is rotatably supported on the toolmounting plate 14102. The first rotary driven gear assembly 14084 is inmeshing engagement with a third rotary driven gear assembly 14086 thatis rotatably supported on the tool mounting plate 14102 and which is inmeshing engagement with a fourth rotary driven gear assembly 14088 thatis in meshing engagement with a threaded portion 14094 of drive shaftassembly 14090 that is coupled to the knife bar 14092. Rotation of therotary drive gear 14082 in a second rotary direction will result in theaxial advancement of the drive shaft assembly 14090 and knife bar 14092in the distal direction “DD”. Conversely, rotation of the rotary drivegear 14082 in a secondary rotary direction (opposite to the secondrotary direction) will cause the drive shaft assembly 14090 and theknife bar 14092 to move in the proximal direction. Movement of thefiring bar 14092 in the proximal direction “PD” will drive the cuttingelement 31860 in the distal direction “DD”. Conversely, movement of thefiring bar 41092 in the distal direction “DD” will result in themovement of the cutting element 13860 in the proximal direction “PD”.

FIGS. 176-182 illustrate yet another surgical tool 15000 that may beeffectively employed in connection with a robotic system 11000. Invarious forms, the surgical tool 15000 includes a surgical end effector15012 in the form of a surgical stapling instrument that includes anelongated channel 15020 and a pivotally translatable clamping member,such as an anvil 15070, which are maintained at a spacing that assureseffective stapling and severing of tissue clamped in the surgical endeffector 15012. As can be seen in FIG. 178, the elongated channel 15020may be substantially U-shaped in cross-section and be fabricated from,for example, titanium, 203 stainless steel, 304 stainless steel, 416stainless steel, 17-4 stainless steel, 17-7 stainless steel, 6061 or7075 aluminum, chromium steel, ceramic, etc. A substantially U-shapedmetal channel pan 15022 may be supported in the bottom of the elongatedchannel 15020 as shown.

Various embodiments include an actuation member in the form of a sledassembly 15030 that is operably supported within the surgical endeffector 15012 and axially movable therein between a starting positionand an ending position in response to control motions applied thereto.In some forms, the metal channel pan 15022 has a centrally-disposed slot15024 therein to movably accommodate a base portion 15032 of the sledassembly 15030. The base portion 15032 includes a foot portion 15034that is sized to be slidably received in a slot 15021 in the elongatedchannel 15020. See FIG. 178. As can be seen in FIGS. 177, 178, 181, and182, the base portion 15032 of sled assembly 15030 includes an axiallyextending threaded bore 15036 that is configured to be threadedlyreceived on a threaded drive shaft 15130 as will be discussed in furtherdetail below. In addition, the sled assembly 15030 includes anupstanding support portion 15038 that supports a tissue cutting blade ortissue cutting instrument 15040. The upstanding support portion 15038terminates in a top portion 15042 that has a pair of laterally extendingretaining fins 15044 protruding therefrom. As shown in FIG. 178, thefins 15044 are positioned to be received within corresponding slots15072 in anvil 15070. The fins 15044 and the foot 15034 serve to retainthe anvil 15070 in a desired spaced closed position as the sled assembly15030 is driven distally through the tissue clamped within the surgicalend effector 15014. As can also be seen in FIGS. 180 and 182, the sledassembly 15030 further includes a reciprocatably or sequentiallyactivatable drive assembly 15050 for driving staple pushers toward theclosed anvil 15070.

More specifically and with reference to FIGS. 178 and 179, the elongatedchannel 15020 is configured to operably support a surgical staplecartridge 15080 therein. In at least one form, the surgical staplecartridge 15080 comprises a body portion 15082 that may be fabricatedfrom, for example, Vectra, Nylon (6/6 or 6/12) and include a centrallydisposed slot 15084 for accommodating the upstanding support portion15038 of the sled assembly 15030. See FIG. 178. These materials couldalso be filled with glass, carbon, or mineral fill of 10%-40%. Thesurgical staple cartridge 15080 further includes a plurality of cavities15086 for movably supporting lines or rows of staple-supporting pushers15088 therein. The cavities 15086 may be arranged in spacedlongitudinally extending lines or rows 15090, 15092, 15094, 15096. Forexample, the rows 15090 may be referred to herein as first outboardrows. The rows 15092 may be referred to herein as first inboard rows.The rows 15094 may be referred to as second inboard rows and the rows15096 may be referred to as second outboard rows. The first inboard row15090 and the first outboard row 15092 are located on a first lateralside of the longitudinal slot 15084 and the second inboard row 15094 andthe second outboard row 15096 are located on a second lateral side ofthe longitudinal slot 15084. The first staple pushers 15088 in the firstinboard row 15092 are staggered in relationship to the first staplepushers 15088 in the first outboard row 15090. Similarly, the secondstaple pushers 15088 in the second outboard row 15096 are staggered inrelationship to the second pushers 15088 in the second inboard row15094. Each pusher 15088 operably supports a surgical staple 15098thereon.

In various embodiments, the sequentially-activatable orreciprocatably—activatable drive assembly 15050 includes a pair ofoutboard drivers 15052 and a pair of inboard drivers 15054 that are eachattached to a common shaft 15056 that is rotatably mounted within thebase 15032 of the sled assembly 15030. The outboard drivers 15052 areoriented to sequentially or reciprocatingly engage a correspondingplurality of outboard activation cavities 15026 provided in the channelpan 15022. Likewise, the inboard drivers 15054 are oriented tosequentially or reciprocatingly engage a corresponding plurality ofinboard activation cavities 15028 provided in the channel pan 15022. Theinboard activation cavities 15028 are arranged in a staggeredrelationship relative to the adjacent outboard activation cavities15026. See FIG. 179. As can also be seen in FIGS. 179 and 181, in atleast one embodiment, the sled assembly 15030 further includes distalwedge segments 15060 and intermediate wedge segments 15062 located oneach side of the bore 15036 to engage the pushers 15088 as the sledassembly 15030 is driven distally in the distal direction “DD”. Asindicated above, the sled assembly 15030 is threadedly received on athreaded portion 15132 of a drive shaft 15130 that is rotatablysupported within the end effector 15012. In various embodiments, forexample, the drive shaft 15130 has a distal end 15134 that is supportedin a distal bearing 15136 mounted in the surgical end effector 15012.See FIGS. 178 and 179.

In various embodiments, the surgical end effector 15012 is coupled to atool mounting portion 15200 by an elongated shaft assembly 15108. In atleast one embodiment, the tool mounting portion 15200 operably supportsa transmission arrangement generally designated as 15204 that isconfigured to receive rotary output motions from the robotic system. Theelongated shaft assembly 15108 includes an outer closure tube 15110 thatis rotatable and axially movable on a spine member 15120 that is rigidlycoupled to a tool mounting plate 15201 of the tool mounting portion15200. The spine member 15120 also has a distal end 15122 that iscoupled to the elongated channel portion 15020 of the surgical endeffector 15012.

In use, it may be desirable to rotate the surgical end effector 15012about a longitudinal tool axis LT-LT defined by the elongated shaftassembly 15008. In various embodiments, the outer closure tube 15110 hasa proximal end 15112 that is rotatably supported on the tool mountingplate 15201 of the tool drive portion 15200 by a forward support cradle15203. The proximal end 15112 of the outer closure tube 15110 isconfigured to operably interface with a rotation transmission portion15206 of the transmission arrangement 15204. In various embodiments, theproximal end 15112 of the outer closure tube 15110 is also supported ona closure sled 15140 that is also movably supported on the tool mountingplate 15201. A closure tube gear segment 15114 is formed on the proximalend 15112 of the outer closure tube 15110 for meshing engagement with arotation drive assembly 15150 of the rotation transmission 15206. As canbe seen in FIG. 176, the rotation drive assembly 15150, in at least oneembodiment, comprises a rotation drive gear 15152 that is coupled to acorresponding first one of the driven discs or elements 11304 on theadapter side 11307 of the tool mounting plate 15201 when the tool driveportion 15200 is coupled to the tool holder 11270. The rotation driveassembly 15150 further comprises a rotary driven gear 15154 that isrotatably supported on the tool mounting plate 15201 in meshingengagement with the closure tube gear segment 15114 and the rotationdrive gear 15152. Application of a first rotary control motion from therobotic system 11000 through the tool holder 11270 and the adapter 11240to the corresponding driven element 11304 will thereby cause rotation ofthe rotation drive gear 15152. Rotation of the rotation drive gear 15152ultimately results in the rotation of the elongated shaft assembly 15108(and the end effector 15012) about the longitudinal tool axis LT-LT(represented by arrow “R” in FIG. 176).

Closure of the anvil 15070 relative to the surgical staple cartridge15080 is accomplished by axially moving the outer closure tube 15110 inthe distal direction “DD”. Such axial movement of the outer closure tube15110 may be accomplished by a closure transmission portion 15144 of thetransmission arrangement 15204. As indicated above, in variousembodiments, the proximal end 15112 of the outer closure tube 15110 issupported by the closure sled 15140 which enables the proximal end 15112to rotate relative thereto, yet travel axially with the closure sled15140. In particular, as can be seen in FIG. 176, the closure sled 15140has an upstanding tab 15141 that extends into a radial groove 15115 inthe proximal end portion 15112 of the outer closure tube 15110. Inaddition, as was described above, the closure sled 15140 is slidablymounted to the tool mounting plate 15201. In various embodiments, theclosure sled 15140 has an upstanding portion 15142 that has a closurerack gear 15143 formed thereon. The closure rack gear 15143 isconfigured for driving engagement with the closure transmission 15144.

In various forms, the closure transmission 15144 includes a closure spurgear 15145 that is coupled to a corresponding second one of the drivendiscs or elements 11304 on the adapter side 11307 of the tool mountingplate 15201. Thus, application of a second rotary control motion fromthe robotic system 11000 through the tool holder 11270 and the adapter11240 to the corresponding second driven element 11304 will causerotation of the closure spur gear 15145 when the interface 11230 iscoupled to the tool mounting portion 15200. The closure transmission15144 further includes a driven closure gear set 15146 that is supportedin meshing engagement with the closure spur gear 15145 and the closurerack gear 15143. Thus, application of a second rotary control motionfrom the robotic system 11000 through the tool holder 11270 and theadapter 11240 to the corresponding second driven element 11304 willcause rotation of the closure spur gear 15145 and ultimately drive theclosure sled 15140 and the outer closure tube 15110 axially. The axialdirection in which the closure tube 15110 moves ultimately depends uponthe direction in which the second driven element 11304 is rotated. Forexample, in response to one rotary closure motion received from therobotic system 11000, the closure sled 15140 will be driven in thedistal direction “DD” and ultimately the outer closure tube 15110 willbe driven in the distal direction as well. The outer closure tube 15110has an opening 15117 in the distal end 15116 that is configured forengagement with a tab 15071 on the anvil 15070 in the manners describedabove. As the outer closure tube 15110 is driven distally, the proximalend 15116 of the closure tube 15110 will contact the anvil 15070 andpivot it closed. Upon application of an “opening” rotary motion from therobotic system 11000, the closure sled 15140 and outer closure tube15110 will be driven in the proximal direction “PD” and pivot the anvil15070 to the open position in the manners described above.

In at least one embodiment, the drive shaft 15130 has a proximal end15137 that has a proximal shaft gear 15138 attached thereto. Theproximal shaft gear 15138 is supported in meshing engagement with adistal drive gear 15162 attached to a rotary drive bar 15160 that isrotatably supported with spine member 15120. Rotation of the rotarydrive bar 15160 and ultimately rotary drive shaft 15130 is controlled bya rotary knife transmission 15207 which comprises a portion of thetransmission arrangement 15204 supported on the tool mounting plate15210. In various embodiments, the rotary knife transmission 15207comprises a rotary knife drive system 15170 that is operably supportedon the tool mounting plate 15201. In various embodiments, the knifedrive system 15170 includes a rotary drive gear 15172 that is coupled toa corresponding third one of the driven discs or elements 11304 on theadapter side of the tool mounting plate 15201 when the tool driveportion 15200 is coupled to the tool holder 11270. The knife drivesystem 15170 further comprises a first rotary driven gear 15174 that isrotatably supported on the tool mounting plate 15201 in meshingengagement with a second rotary driven gear 15176 and the rotary drivegear 15172. The second rotary driven gear 15176 is coupled to a proximalend portion 15164 of the rotary drive bar 15160.

Rotation of the rotary drive gear 15172 in a first rotary direction willresult in the rotation of the rotary drive bar 15160 and rotary driveshaft 15130 in a first direction. Conversely, rotation of the rotarydrive gear 15172 in a second rotary direction (opposite to the firstrotary direction) will cause the rotary drive bar 15160 and rotary driveshaft 15130 to rotate in a second direction.

One method of operating the surgical tool 15000 will now be described.The tool drive 15200 is operably coupled to the interface 11240 of therobotic system 11000. The controller 11001 of the robotic system 11000is operated to locate the tissue to be cut and stapled between the openanvil 15070 and the surgical staple cartridge 15080. Once the surgicalend effector 15012 has been positioned by the robot system 11000 suchthat the target tissue is located between the anvil 15070 and thesurgical staple cartridge 15080, the controller 11001 of the roboticsystem 11000 may be activated to apply the second rotary output motionto the second driven element 11304 coupled to the closure spur gear15145 to drive the closure sled 15140 and the outer closure tube 15110axially in the distal direction to pivot the anvil 15070 closed in themanner described above. Once the robotic controller 11001 determinesthat the anvil 15070 has been closed by, for example, sensors in thesurgical end effector 15012 and/or the tool drive portion 15200, therobotic controller 11001 system may provide the surgeon with anindication that signifies the closure of the anvil. Such indication maybe, for example, in the form of a light and/or audible sound, tactilefeedback on the control members, etc. Then the surgeon may initiate thefiring process. In alternative embodiments, however, the roboticcontroller 11001 may automatically commence the firing process.

To commence the firing process, the robotic controller applies a thirdrotary output motion to the third driven disc or element 11304 coupledto the rotary drive gear 15172. Rotation of the rotary drive gear 15172results in the rotation of the rotary drive bar 15160 and rotary driveshaft 15130 in the manner described above. Firing and formation of thesurgical staples 15098 can be best understood from reference to FIGS.177, 179, and 180. As the sled assembly 15030 is driven in the distaldirection “DD” through the surgical staple cartridge 15080, the distalwedge segments 15060 first contact the staple pushers 15088 and start tomove them toward the closed anvil 15070. As the sled assembly 15030continues to move distally, the outboard drivers 15052 will drop intothe corresponding activation cavity 15026 in the channel pan 15022. Theopposite end of each outboard driver 15052 will then contact thecorresponding outboard pusher 15088 that has moved up the distal andintermediate wedge segments 15060, 15062. Further distal movement of thesled assembly 15030 causes the outboard drivers 15052 to rotate anddrive the corresponding pushers 15088 toward the anvil 15070 to causethe staples 15098 supported thereon to be formed as they are driven intothe anvil 15070. It will be understood that as the sled assembly 15030moves distally, the knife blade 15040 cuts through the tissue that isclamped between the anvil and the staple cartridge. Because the inboarddrivers 15054 and outboard drivers 15052 are attached to the same shaft15056 and the inboard drivers 15054 are radially offset from theoutboard drivers 15052 on the shaft 15056, as the outboard drivers 15052are driving their corresponding pushers 15088 toward the anvil 15070,the inboard drivers 15054 drop into their next corresponding activationcavity 15028 to cause them to rotatably or reciprocatingly drive thecorresponding inboard pushers 15088 towards the closed anvil 15070 inthe same manner. Thus, the laterally corresponding outboard staples15098 on each side of the centrally disposed slot 15084 aresimultaneously formed together and the laterally corresponding inboardstaples 15098 on each side of the slot 15084 are simultaneously formedtogether as the sled assembly 15030 is driven distally. Once the roboticcontroller 11001 determines that the sled assembly 15030 has reached itsdistal most position—either through sensors or through monitoring theamount of rotary input applied to the drive shaft 15130 and/or therotary drive bar 15160, the controller 11001 may then apply a thirdrotary output motion to the drive shaft 15130 to rotate the drive shaft15130 in an opposite direction to retract the sled assembly 15030 backto its starting position. Once the sled assembly 15030 has beenretracted to the starting position (as signaled by sensors in the endeffector 15012 and/or the tool drive portion 15200), the application ofthe second rotary motion to the drive shaft 15130 is discontinued.Thereafter, the surgeon may manually activate the anvil opening processor it may be automatically commenced by the robotic controller 11001. Toopen the anvil 15070, the second rotary output motion is applied to theclosure spur gear 15145 to drive the closure sled 15140 and the outerclosure tube 15110 axially in the proximal direction. As the closuretube 15110 moves proximally, the opening 15117 in the distal end 15116of the closure tube 15110 contacts the tab 15071 on the anvil 15070 topivot the anvil 15070 to the open position. A spring may also beemployed to bias the anvil 15070 to the open position when the closuretube 15116 has been returned to the starting position. Again, sensors inthe surgical end effector 15012 and/or the tool mounting portion 15200may provide the robotic controller 11001 with a signal indicating thatthe anvil 15070 is now open. Thereafter, the surgical end effector 15012may be withdrawn from the surgical site.

FIGS. 183-188 diagrammatically depict the sequential firing of staplesin a surgical tool assembly 15000′ that is substantially similar to thesurgical tool assembly 15000 described above. In this embodiment, theinboard and outboard drivers 15052′, 15054′ have a cam-like shape with acam surface 15053 and an actuator protrusion 15055 as shown in FIGS.183-189. The drivers 15052′, 15054′ are journaled on the same shaft15056′ that is rotatably supported by the sled assembly 15030′. In thisembodiment, the sled assembly 15030′ has distal wedge segments 15060′for engaging the pushers 15088. FIG. 183 illustrates an initial positionof two inboard or outboard drivers 15052′, 15054′ as the sled assembly15030′ is driven in the distal direction “DD”. As can be seen in thatFigure, the pusher 15088 a has advanced up the wedge segment 15060′ andhas contacted the driver 15052′, 15054′. Further travel of the sledassembly 15030′ in the distal direction causes the driver 15052′, 15054′to pivot in the “P” direction (FIG. 184) until the actuator portion15055 contacts the end wall 15029 a of the activation cavity 15026,15028 as shown in FIG. 185. Continued advancement of the sled assembly15030′ in the distal direction “DD” causes the driver 15052′, 15054′ torotate in the “D” direction as shown in FIG. 186. As the driver 15052′,15054′ rotates, the pusher 15088 a rides up the cam surface 15053 to thefinal vertical position shown in FIG. 187. When the pusher 15088 areaches the final vertical position shown in FIGS. 187 and 188, thestaple (not shown) supported thereon has been driven into the stapleforming surface of the anvil to form the staple.

FIGS. 190-195 illustrate a surgical end effector 15312 that may beemployed for example, in connection with the tool mounting portion 11300and shaft 12008 described in detail above. In various forms, thesurgical end effector 15312 includes an elongated channel 15322 that isconstructed as described above for supporting a surgical staplecartridge 15330 therein. The surgical staple cartridge 15330 comprises abody portion 15332 that includes a centrally disposed slot 15334 foraccommodating an upstanding support portion 15386 of a sled assembly15380. See FIGS. 190-192. The surgical staple cartridge body portion15332 further includes a plurality of cavities 15336 for movablysupporting staple-supporting pushers 15350 therein. The cavities 15336may be arranged in spaced longitudinally extending rows 15340, 15342,15344, 15346. The rows 15340, 15342 are located on one lateral side ofthe longitudinal slot 15334 and the rows 15344, 15346 are located on theother side of longitudinal slot 15334. In at least one embodiment, thepushers 15350 are configured to support two surgical staples 15352thereon. In particular, each pusher 15350 located on one side of theelongated slot 15334 supports one staple 15352 in row 15340 and onestaple 15352 in row 15342 in a staggered orientation. Likewise, eachpusher 15350 located on the other side of the elongated slot 15334supports one surgical staple 15352 in row 15344 and another surgicalstaple 15352 in row 15346 in a staggered orientation. Thus, every pusher15350 supports two surgical staples 15352.

As can be further seen in FIGS. 190, 191, the surgical staple cartridge15330 includes a plurality of rotary drivers 15360. More particularly,the rotary drivers 15360 on one side of the elongated slot 15334 arearranged in a single line 15370 and correspond to the pushers 15350 inlines 15340, 15342. In addition, the rotary drivers 15360 on the otherside of the elongated slot 15334 are arranged in a single line 15372 andcorrespond to the pushers 15350 in lines 15344, 15346. As can be seen inFIG. 190, each rotary driver 15360 is rotatably supported within thestaple cartridge body 15332. More particularly, each rotary driver 15360is rotatably received on a corresponding driver shaft 15362. Each driver15360 has an arcuate ramp portion 15364 formed thereon that isconfigured to engage an arcuate lower surface 15354 formed on eachpusher 15350. See FIG. 195. In addition, each driver 15360 has a lowersupport portion 15366 extend therefrom to slidably support the pusher15360 on the channel 15322. Each driver 15360 has a downwardly extendingactuation rod 15368 that is configured for engagement with a sledassembly 15380.

As can be seen in FIG. 192, in at least one embodiment, the sledassembly 15380 includes a base portion 15382 that has a foot portion15384 that is sized to be slidably received in a slot 15333 in thechannel 15322. See FIG. 190. The sled assembly 15380 includes anupstanding support portion 15386 that supports a tissue cutting blade ortissue cutting instrument 15388. The upstanding support portion 15386terminates in a top portion 15390 that has a pair of laterally extendingretaining fins 15392 protruding therefrom. The fins 15392 are positionedto be received within corresponding slots (not shown) in the anvil (notshown). As with the above-described embodiments, the fins 15392 and thefoot portion 15384 serve to retain the anvil (not shown) in a desiredspaced closed position as the sled assembly 15380 is driven distallythrough the tissue clamped within the surgical end effector 15312. Theupstanding support portion 15386 is configured for attachment to a knifebar 12200 (FIG. 111). The sled assembly 15380 further has ahorizontally-extending actuator plate 15394 that is shaped for actuatingengagement with each of the actuation rods 15368 on the pushers 15360.

Operation of the surgical end effector 15312 will now be explained withreference to FIGS. 190 and 191. As the sled assembly 15380 is driven inthe distal direction “DD” through the staple cartridge 15330, theactuator plate 15394 sequentially contacts the actuation rods 15368 onthe pushers 15360. As the sled assembly 15380 continues to movedistally, the actuator plate 15394 sequentially contacts the actuatorrods 15368 of the drivers 15360 on each side of the elongated slot15334. Such action causes the drivers 15360 to rotate from a firstunactuated position to an actuated portion wherein the pushers 15350 aredriven towards the closed anvil. As the pushers 15350 are driven towardthe anvil, the surgical staples 15352 thereon are driven into formingcontact with the underside of the anvil. Once the robotic system 11000determines that the sled assembly 15080 has reached its distal mostposition through sensors or other means, the control system of therobotic system 11000 may then retract the knife bar and sled assembly15380 back to the starting position. Thereafter, the robotic controlsystem may then activate the procedure for returning the anvil to theopen position to release the stapled tissue.

FIGS. 196-200 depict one form of an automated reloading systemembodiment of the present invention, generally designated as 15500. Inone form, the automated reloading system 15500 is configured to replacea “spent” surgical end effector component in a manipulatable surgicaltool portion of a robotic surgical system with a “new” surgical endeffector component. As used herein, the term “surgical end effectorcomponent” may comprise, for example, a surgical staple cartridge, adisposable loading unit or other end effector components that, whenused, are spent and must be replaced with a new component. Furthermore,the term “spent” means that the end effector component has beenactivated and is no longer useable for its intended purpose in itspresent state. For example, in the context of a surgical staplecartridge or disposable loading unit, the term “spent” means that atleast some of the unformed staples that were previously supportedtherein have been “fired” therefrom. As used herein, the term “new”surgical end effector component refers to an end effector component thatis in condition for its intended use. In the context of a surgicalstaple cartridge or disposable loading unit, for example, the term “new”refers to such a component that has unformed staples therein and whichis otherwise ready for use.

In various embodiments, the automated reloading system 15500 includes abase portion 15502 that may be strategically located within a workenvelope 11109 of a robotic arm cart 11100 (FIG. 97) of a robotic system11000. As used herein, the term “manipulatable surgical tool portion”collectively refers to a surgical tool of the various types disclosedherein and other forms of surgical robotically-actuated tools that areoperably attached to, for example, a robotic arm cart 11100 or similardevice that is configured to automatically manipulate and actuate thesurgical tool. The term “work envelope” as used herein refers to therange of movement of the manipulatable surgical tool portion of therobotic system. FIG. 97 generally depicts an area that may comprise awork envelope of the robotic arm cart 11100. Those of ordinary skill inthe art will understand that the shape and size of the work envelopedepicted therein is merely illustrative. The ultimate size, shape andlocation of a work envelope will ultimately depend upon theconstruction, range of travel limitations, and location of themanipulatable surgical tool portion. Thus, the term “work envelope” asused herein is intended to cover a variety of different sizes and shapesof work envelopes and should not be limited to the specific size andshape of the sample work envelope depicted in FIG. 97.

As can be seen in FIG. 196, the base portion 15502 includes a newcomponent support section or arrangement 15510 that is configured tooperably support at least one new surgical end effector component in a“loading orientation”. As used herein, the term “loading orientation”means that the new end effector component is supported in such away soas to permit the corresponding component support portion of themanipulatable surgical tool portion to be brought into loadingengagement with (i.e., operably seated or operably attached to) the newend effector component (or the new end effector component to be broughtinto loading engagement with the corresponding component support portionof the manipulatable surgical tool portion) without human interventionbeyond that which may be necessary to actuate the robotic system. Aswill be further appreciated as the present Detailed Descriptionproceeds, in at least one embodiment, the preparation nurse will loadthe new component support section before the surgery with theappropriate length and color cartridges (some surgical staple cartridgesmay support certain sizes of staples the size of which may be indicatedby the color of the cartridge body) required for completing the surgicalprocedure. However, no direct human interaction is necessary during thesurgery to reload the robotic endocutter. In one form, the surgical endeffector component comprises a staple cartridge 12034 that is configuredto be operably seated within a component support portion (elongatedchannel) of any of the various other end effector arrangements describedabove. For explanation purposes, new (unused) cartridges will bedesignated as “12034 a” and spent cartridges will be designated as“12034 b”. The Figures depict cartridges 12034 a, 12034 b designed foruse with a surgical end effector 12012 that includes a channel 12022 andan anvil 12024, the construction and operation of which were discussedin detail above. Cartridges 12034 a, 12034 b are identical to cartridges12034 described above. In various embodiments, the cartridges 12034 a,12034 b are configured to be snappingly retained (i.e., loadingengagement) within the channel 12022 of a surgical end effector 12012.As the present Detailed Description proceeds, however, those of ordinaryskill in the art will appreciate that the unique and novel features ofthe automated cartridge reloading system 15500 may be effectivelyemployed in connection with the automated removal and installation ofother cartridge arrangements without departing from the spirit and scopeof the present invention.

In the depicted embodiment, the term “loading orientation” means thatthe distal tip portion 12035 a of the a new surgical staple cartridge12034 a is inserted into a corresponding support cavity 15512 in the newcartridge support section 15510 such that the proximal end portion 12037a of the new surgical staple cartridge 12034 a is located in aconvenient orientation for enabling the arm cart 11100 to manipulate thesurgical end effector 12012 into a position wherein the new cartridge12034 a may be automatically loaded into the channel 12022 of thesurgical end effector 12012. In various embodiments, the base 15502includes at least one sensor 15504 which communicates with the controlsystem 11003 of the robotic controller 11001 to provide the controlsystem 11003 with the location of the base 15502 and/or the reloadlength and color doe each staged or new cartridge 12034 a.

As can also be seen in the Figures, the base 15502 further includes acollection receptacle 15520 that is configured to collect spentcartridges 12034 b that have been removed or disengaged from thesurgical end effector 12012 that is operably attached to the roboticsystem 11000. In addition, in one form, the automated reloading system15500 includes an extraction system 15530 for automatically removing thespent end effector component from the corresponding support portion ofthe end effector or manipulatable surgical tool portion without specifichuman intervention beyond that which may be necessary to activate therobotic system. In various embodiments, the extraction system 15530includes an extraction hook member 15532. In one form, for example, theextraction hook member 15532 is rigidly supported on the base portion15502. In one embodiment, the extraction hook member has at least onehook 5534 formed thereon that is configured to hookingly engage thedistal end 12035 of a spent cartridge 12034 b when it is supported inthe elongated channel 12022 of the surgical end effector 12012. Invarious forms, the extraction hook member 15532 is conveniently locatedwithin a portion of the collection receptacle 15520 such that when thespent end effector component (cartridge 12034 b) is brought intoextractive engagement with the extraction hook member 15532, the spentend effector component (cartridge 12034 b) is dislodged from thecorresponding component support portion (elongated channel 12022), andfalls into the collection receptacle 15020. Thus, to use thisembodiment, the manipulatable surgical tool portion manipulates the endeffector attached thereto to bring the distal end 12035 of the spentcartridge 12034 b therein into hooking engagement with the hook 15534and then moves the end effector in such a way to dislodge the spentcartridge 12034 b from the elongated channel 12022.

In other arrangements, the extraction hook member 15532 comprises arotatable wheel configuration that has a pair of diametrically-opposedhooks 15334 protruding therefrom. See FIGS. 196 and 199. The extractionhook member 15532 is rotatably supported within the collectionreceptacle 15520 and is coupled to an extraction motor 15540 that iscontrolled by the controller 11001 of the robotic system. This form ofthe automated reloading system 15500 may be used as follows. FIG. 198illustrates the introduction of the surgical end effector 12012 that isoperably attached to the manipulatable surgical tool portion 11200. Ascan be seen in that Figure, the arm cart 11100 of the robotic system11000 locates the surgical end effector 12012 in the shown positionwherein the hook end 15534 of the extraction member 15532 hookinglyengages the distal end 12035 of the spent cartridge 12034 b in thesurgical end effector 12012. The anvil 12024 of the surgical endeffector 12012 is in the open position. After the distal end 12035 ofthe spent cartridge 12034 b is engaged with the hook end 15532, theextraction motor 15540 is actuated to rotate the extraction wheel 15532to disengage the spent cartridge 12034 b from the channel 12022. Toassist with the disengagement of the spent cartridge 12034 b from thechannel 12022 (or if the extraction member 15530 is stationary), therobotic system 11000 may move the surgical end effector 12012 in anupward direction (arrow “U” in FIG. 199). As the spent cartridge 12034 bis dislodged from the channel 12022, the spent cartridge 12034 b fallsinto the collection receptacle 15520. Once the spent cartridge 12034 bhas been removed from the surgical end effector 12012, the roboticsystem 11000 moves the surgical end effector 12012 to the position shownin FIG. 200.

In various embodiments, a sensor arrangement 15533 is located adjacentto the extraction member 15532 that is in communication with thecontroller 11001 of the robotic system 11000. The sensor arrangement15533 may comprise a sensor that is configured to sense the presence ofthe surgical end effector 12012 and, more particularly the tip 12035 bof the spent surgical staple cartridge 12034 b thereof as the distal tipportion 12035 b is brought into engagement with the extraction member15532. In some embodiments, the sensor arrangement 15533 may comprise,for example, a light curtain arrangement. However, other forms ofproximity sensors may be employed. In such arrangement, when thesurgical end effector 12012 with the spent surgical staple cartridge12034 b is brought into extractive engagement with the extraction member15532, the sensor senses the distal tip 12035 b of the surgical staplecartridge 12034 b (e.g., the light curtain is broken). When theextraction member 15532 spins and pops the surgical staple cartridge12034 b loose and it falls into the collection receptacle 15520, thelight curtain is again unbroken. Because the surgical end effector 12012was not moved during this procedure, the robotic controller 11001 isassured that the spent surgical staple cartridge 12034 b has beenremoved therefrom. Other sensor arrangements may also be successfullyemployed to provide the robotic controller 11001 with an indication thatthe spent surgical staple cartridge 12034 b has been removed from thesurgical end effector 12012.

As can be seen in FIG. 200, the surgical end effector 12012 ispositioned to grasp a new surgical staple cartridge 12034 a between thechannel 12022 and the anvil 12024. More specifically, as shown in FIGS.197 and 200, each cavity 11512 has a corresponding upstanding pressurepad 15514 associated with it. The surgical end effector 12012 is locatedsuch that the pressure pad 15514 is located between the new cartridge12034 a and the anvil 12024. Once in that position, the robotic system11000 closes the anvil 12024 onto the pressure pad 15514 which serves topush the new cartridge 12034 a into snapping engagement with the channel12022 of the surgical end effector 12012. Once the new cartridge 12034 ahas been snapped into position within the elongated channel 12022, therobotic system 11000 then withdraws the surgical end effector 12012 fromthe automated cartridge reloading system 15500 for use in connectionwith performing another surgical procedure.

FIGS. 201-205 depict another automated reloading system 15600 that maybe used to remove a spent disposable loading unit 13612 from amanipulatable surgical tool arrangement 13600 (FIGS. 148-161) that isoperably attached to an arm cart 11100 or other portion of a roboticsystem 11000 and reload a new disposable loading unit 13612 therein. Ascan be seen in FIGS. 201 and 202, one form of the automated reloadingsystem 15600 includes a housing 15610 that has a movable supportassembly in the form of a rotary carrousel top plate 15620 supportedthereon which cooperates with the housing 15610 to form a hollowenclosed area 15612. The automated reloading system 15600 is configuredto be operably supported within the work envelop of the manipulatablesurgical tool portion of a robotic system as was described above. Invarious embodiments, the rotary carrousel plate 15620 has a plurality ofholes 15622 for supporting a plurality of orientation tubes 15660therein. As can be seen in FIGS. 202 and 203, the rotary carrousel plate15620 is affixed to a spindle shaft 15624. The spindle shaft 15624 iscentrally disposed within the enclosed area 15612 and has a spindle gear15626 attached thereto. The spindle gear 15626 is in meshing engagementwith a carrousel drive gear 15628 that is coupled to a carrousel drivemotor 15630 that is in operative communication with the roboticcontroller 11001 of the robotic system 11000.

Various embodiments of the automated reloading system 15600 may alsoinclude a carrousel locking assembly, generally designated as 15640. Invarious forms, the carrousel locking assembly 15640 includes a cam disc15642 that is affixed to the spindle shaft 15624. The spindle gear 15626may be attached to the underside of the cam disc 15642 and the cam disc15642 may be keyed onto the spindle shaft 15624. In alternativearrangements, the spindle gear 15626 and the cam disc 15642 may beindependently non-rotatably affixed to the spindle shaft 15624. As canbe seen in FIGS. 202 and 203, a plurality of notches 15644 are spacedaround the perimeter of the cam disc 15642. A locking arm 15648 ispivotally mounted within the housing 15610 and is biased into engagementwith the perimeter of the cam disc 15642 by a locking spring 15649. Ascan be seen in FIG. 201, the outer perimeter of the cam disc 15642 isrounded to facilitate rotation of the cam disc 15642 relative to thelocking arm 15648. The edges of each notch 15644 are also rounded suchthat when the cam disc 15642 is rotated, the locking arm 15648 is cammedout of engagement with the notches 15644 by the perimeter of the camdisc 15642.

Various forms of the automated reloading system 15600 are configured tosupport a portable/replaceable tray assembly 15650 that is configured tosupport a plurality of disposable loading units 13612 in individualorientation tubes 15660. More specifically and with reference to FIGS.202 and 203, the replaceable tray assembly 15650 comprises a tray 15652that has a centrally-disposed locator spindle 15654 protruding from theunderside thereof. The locator spindle 15654 is sized to be receivedwithin a hollow end 15625 of spindle shaft 15624. The tray 15652 has aplurality of holes 15656 therein that are configured to support anorientation tube 15660 therein. Each orientation tube 15660 is orientedwithin a corresponding hole 15656 in the replaceable tray assembly 15650in a desired orientation by a locating fin 15666 on the orientation tube15660 that is designed to be received within a corresponding locatingslot 15658 in the tray assembly 15650. In at least one embodiment, thelocating fin 15666 has a substantially V-shaped cross-sectional shapethat is sized to fit within a V-shaped locating slot 15658. Sucharrangement serves to orient the orientation tube 15660 in a desiredstarting position while enabling it to rotate within the hole 15656 whena rotary motion is applied thereto. That is, when a rotary motion isapplied to the orientation tube 15660 the V-shaped locating fin 15666will pop out of its corresponding locating slot enabling the tube 15660to rotate relative to the tray 15652 as will be discussed in furtherdetail below. As can also be seen in FIGS. 201-203, the replaceable tray15652 may be provided with one or more handle portions 15653 tofacilitate transport of the tray assembly 15652 when loaded withorientation tubes 15660.

As can be seen in FIG. 205, each orientation tube 15660 comprises a bodyportion 15662 that has a flanged open end 15664. The body portion 15662defines a cavity 15668 that is sized to receive a portion of adisposable loading unit 13612 therein. To properly orient the disposableloading unit 13612 within the orientation tube 15660, the cavity 15668has a flat locating surface 15670 formed therein. As can be seen in FIG.205, the flat locating surface 15670 is configured to facilitate theinsertion of the disposable loading unit into the cavity 15668 in adesired or predetermined non-rotatable orientation. In addition, the end15669 of the cavity 15668 may include a foam or cushion material 15672that is designed to cushion the distal end of the disposable loadingunit 13612 within the cavity 15668. Also, the length of the locatingsurface may cooperate with a sliding support member 13689 of the axialdrive assembly 13680 of the disposable loading unit 13612 to furtherlocate the disposable loading unit 13612 at a desired position withinthe orientation tube 15660.

The orientation tubes 15660 may be fabricated from Nylon, polycarbonate,polyethylene, liquid crystal polymer, 6061 or 7075 aluminum, titanium,300 or 400 series stainless steel, coated or painted steel, platedsteel, etc. and, when loaded in the replaceable tray 15662 and thelocator spindle 15654 is inserted into the hollow end 15625 of spindleshaft 15624, the orientation tubes 15660 extend through correspondingholes 15662 in the carrousel top plate 15620. Each replaceable tray15662 is equipped with a location sensor 15663 that communicates withthe control system 11003 of the controller 11001 of the robotic system11000. The sensor 15663 serves to identify the location of the reloadsystem, and the number, length, color and fired status of each reloadhoused in the tray. In addition, an optical sensor or sensors 15665 thatcommunicate with the robotic controller 11001 may be employed to sensethe type/size/length of disposable loading units that are loaded withinthe tray 15662.

Various embodiments of the automated reloading system 15600 furtherinclude a drive assembly 15680 for applying a rotary motion to theorientation tube 15660 holding the disposable loading unit 13612 to beattached to the shaft 13700 of the surgical tool 13600 (collectively the“manipulatable surgical tool portion”) that is operably coupled to therobotic system. The drive assembly 15680 includes a support yoke 15682that is attached to the locking arm 15648. Thus, the support yoke 15682pivots with the locking arm 15648. The support yoke 15682 rotatablysupports a tube idler wheel 15684 and a tube drive wheel 15686 that isdriven by a tube motor 15688 attached thereto. Tube motor 15688communicates with the control system 11003 and is controlled thereby.The tube idler wheel 15684 and tube drive wheel 15686 are fabricatedfrom, for example, natural rubber, sanoprene, isoplast, etc. such thatthe outer surfaces thereof create sufficient amount of friction toresult in the rotation of an orientation tube 15660 in contact therewithupon activation of the tube motor 15688. The idler wheel 15684 and tubedrive wheel 15686 are oriented relative to each other to create a cradlearea 15687 therebetween for receiving an orientation tube 15060 indriving engagement therein.

In use, one or more of the orientation tubes 15660 loaded in theautomated reloading system 15600 are left empty, while the otherorientation tubes 15660 may operably support a corresponding newdisposable loading unit 13612 therein. As will be discussed in furtherdetail below, the empty orientation tubes 15660 are employed to receivea spent disposable loading unit 13612 therein.

The automated reloading system 15600 may be employed as follows afterthe system 15600 is located within the work envelope of themanipulatable surgical tool portion of a robotic system. If themanipulatable surgical tool portion has a spent disposable loading unit13612 operably coupled thereto, one of the orientation tubes 15660 thatare supported on the replaceable tray 15662 is left empty to receive thespent disposable loading unit 13612 therein. If, however, themanipulatable surgical tool portion does not have a disposable loadingunit 13612 operably coupled thereto, each of the orientation tubes 15660may be provided with a properly oriented new disposable loading unit13612.

As described hereinabove, the disposable loading unit 13612 employs arotary “bayonet-type” coupling arrangement for operably coupling thedisposable loading unit 13612 to a corresponding portion of themanipulatable surgical tool portion. That is, to attach a disposableloading unit 13612 to the corresponding portion of the manipulatablesurgical tool portion (13700—see FIG. 154, 155), a rotary installationmotion must be applied to the disposable loading unit 13612 and/or thecorresponding portion of the manipulatable surgical tool portion whenthose components have been moved into loading engagement with eachother. Such installation motions are collectively referred to herein as“loading motions”. Likewise, to decouple a spent disposable loading unit13612 from the corresponding portion of the manipulatable surgical tool,a rotary decoupling motion must be applied to the spent disposableloading unit 13612 and/or the corresponding portion of the manipulatablesurgical tool portion while simultaneously moving the spent disposableloading unit and the corresponding portion of the manipulatable surgicaltool away from each other. Such decoupling motions are collectivelyreferred to herein as “extraction motions”.

To commence the loading process, the robotic system 11000 is activatedto manipulate the manipulatable surgical tool portion and/or theautomated reloading system 15600 to bring the manipulatable surgicaltool portion into loading engagement with the new disposable loadingunit 13612 that is supported in the orientation tube 15660 that is indriving engagement with the drive assembly 15680. Once the roboticcontroller 11001 (FIG. 96) of the robotic control system 11000 haslocated the manipulatable surgical tool portion in loading engagementwith the new disposable loading unit 13612, the robotic controller 11001activates the drive assembly 15680 to apply a rotary loading motion tothe orientation tube 15660 in which the new disposable loading unit13612 is supported and/or applies another rotary loading motion to thecorresponding portion of the manipulatable surgical tool portion. Uponapplication of such rotary loading motions(s), the robotic controller11001 also causes the corresponding portion of the manipulatablesurgical tool portion to be moved towards the new disposable loadingunit 13612 into loading engagement therewith. Once the disposableloading unit 13612 is in loading engagement with the correspondingportion of the manipulatable tool portion, the loading motions arediscontinued and the manipulatable surgical tool portion may be movedaway from the automated reloading system 15600 carrying with it the newdisposable loading unit 13612 that has been operably coupled thereto.

To decouple a spent disposable loading unit 13612 from a correspondingmanipulatable surgical tool portion, the robotic controller 11001 of therobotic system manipulates the manipulatable surgical tool portion so asto insert the distal end of the spent disposable loading unit 13612 intothe empty orientation tube 15660 that remains in driving engagement withthe drive assembly 15680. Thereafter, the robotic controller 11001activates the drive assembly 15680 to apply a rotary extraction motionto the orientation tube 15660 in which the spent disposable loading unit13612 is supported and/or applies a rotary extraction motion to thecorresponding portion of the manipulatable surgical tool portion. Therobotic controller 11001 also causes the manipulatable surgical toolportion to withdraw away from the spent rotary disposable loading unit13612. Thereafter the rotary extraction motion(s) are discontinued.

After the spent disposable loading unit 13612 has been removed from themanipulatable surgical tool portion, the robotic controller 11001 mayactivate the carrousel drive motor 15630 to index the carrousel topplate 15620 to bring another orientation tube 15660 that supports a newdisposable loading unit 13612 therein into driving engagement with thedrive assembly 15680. Thereafter, the loading process may be repeated toattach the new disposable loading unit 13612 therein to the portion ofthe manipulatable surgical tool portion. The robotic controller 11001may record the number of disposable loading units that have been usedfrom a particular replaceable tray 15652. Once the controller 11001determines that all of the new disposable loading units 13612 have beenused from that tray, the controller 11001 may provide the surgeon with asignal (visual and/or audible) indicating that the tray 15652 supportingall of the spent disposable loading units 13612 must be replaced with anew tray 15652 containing new disposable loading units 13612.

FIGS. 206-211 depict another non-limiting embodiment of a surgical tool16000 of the present invention that is well-adapted for use with arobotic system 11000 that has a tool drive assembly 11010 (FIG. 101)that is operatively coupled to a master controller 11001 that isoperable by inputs from an operator (i.e., a surgeon). As can be seen inFIG. 206, the surgical tool 16000 includes a surgical end effector 16012that comprises an endocutter. In at least one form, the surgical tool16000 generally includes an elongated shaft assembly 16008 that has aproximal closure tube 16040 and a distal closure tube 16042 that arecoupled together by an articulation joint 16100. The surgical tool 16000is operably coupled to the manipulator by a tool mounting portion,generally designated as 16200. The surgical tool 16000 further includesan interface 16030 which may mechanically and electrically couple thetool mounting portion 16200 to the manipulator in the various mannersdescribed in detail above.

In at least one embodiment, the surgical tool 16000 includes a surgicalend effector 16012 that comprises, among other things, at least onecomponent 16024 that is selectively movable between first and secondpositions relative to at least one other component 16022 in response tovarious control motions applied to component 16024 as will be discussedin further detail below to perform a surgical procedure. In variousembodiments, component 16022 comprises an elongated channel 16022configured to operably support a surgical staple cartridge 16034 thereinand component 16024 comprises a pivotally translatable clamping member,such as an anvil 16024. Various embodiments of the surgical end effector16012 are configured to maintain the anvil 16024 and elongated channel16022 at a spacing that assures effective stapling and severing oftissue clamped in the surgical end effector 16012. Unless otherwisestated, the end effector 16012 is similar to the surgical end effector12012 described above and includes a cutting instrument (not shown) anda sled (not shown). The anvil 16024 may include a tab 16027 at itsproximal end that interacts with a component of the mechanical closuresystem (described further below) to facilitate the opening of the anvil16024. The elongated channel 16022 and the anvil 16024 may be made of anelectrically conductive material (such as metal) so that they may serveas part of an antenna that communicates with sensor(s) in the endeffector, as described above. The surgical staple cartridge 16034 couldbe made of a nonconductive material (such as plastic) and the sensor maybe connected to or disposed in the surgical staple cartridge 16034, aswas also described above.

As can be seen in FIG. 206, the surgical end effector 16012 is attachedto the tool mounting portion 16200 by the elongated shaft assembly 16008according to various embodiments. As shown in the illustratedembodiment, the elongated shaft assembly 16008 includes an articulationjoint generally designated as 16100 that enables the surgical endeffector 16012 to be selectively articulated about a first toolarticulation axis AA1-AA1 that is substantially transverse to alongitudinal tool axis LT-LT and a second tool articulation axis AA2-AA2that is substantially transverse to the longitudinal tool axis LT-LT aswell as the first articulation axis AA1-AA1. See FIG. 207. In variousembodiments, the elongated shaft assembly 16008 includes a closure tubeassembly 16009 that comprises a proximal closure tube 16040 and a distalclosure tube 16042 that are pivotably linked by a pivot links 16044 and16046. The closure tube assembly 16009 is movably supported on a spineassembly generally designated as 16102.

As can be seen in FIG. 208, the proximal closure tube 16040 is pivotallylinked to an intermediate closure tube joint 16043 by an upper pivotlink 16044U and a lower pivot link 16044L such that the intermediateclosure tube joint 16043 is pivotable relative to the proximal closuretube 16040 about a first closure axis CA1-CA1 and a second closure axisCA2-CA2. In various embodiments, the first closure axis CA1-CA1 issubstantially parallel to the second closure axis CA2-CA2 and bothclosure axes CA1-CA1, CA2-CA2 are substantially transverse to thelongitudinal tool axis LT-LT. As can be further seen in FIG. 208, theintermediate closure tube joint 16043 is pivotally linked to the distalclosure tube 16042 by a left pivot link 16046L and a right pivot link16046R such that the intermediate closure tube joint 16043 is pivotablerelative to the distal closure tube 16042 about a third closure axisCA3-CA3 and a fourth closure axis CA4-CA4. In various embodiments, thethird closure axis CA3-CA3 is substantially parallel to the fourthclosure axis CA4-CA4 and both closure axes CA3-CA3, CA4-CA4 aresubstantially transverse to the first and second closure axes CA1-CA1,CA2-CA2 as well as to longitudinal tool axis LT-LT.

The closure tube assembly 16009 is configured to axially slide on thespine assembly 16102 in response to actuation motions applied thereto.The distal closure tube 16042 includes an opening 16045 which interfaceswith the tab 16027 on the anvil 16024 to facilitate opening of the anvil16024 as the distal closure tube 16042 is moved axially in the proximaldirection “PD”. The closure tubes 16040, 16042 may be made ofelectrically conductive material (such as metal) so that they may serveas part of the antenna, as described above. Components of the spineassembly 16102 may be made of a nonconductive material (such asplastic).

As indicated above, the surgical tool 16000 includes a tool mountingportion 16200 that is configured for operable attachment to the toolmounting assembly 11010 of the robotic system 11000 in the variousmanners described in detail above. As can be seen in FIG. 210, the toolmounting portion 16200 comprises a tool mounting plate 16202 thatoperably supports a transmission arrangement 16204 thereon. In variousembodiments, the transmission arrangement 16204 includes an articulationtransmission 16142 that comprises a portion of an articulation system16140 for articulating the surgical end effector 16012 about a firsttool articulation axis TA1-TA1 and a second tool articulation axisTA2-TA2. The first tool articulation axis TA1-TA1 is substantiallytransverse to the second tool articulation axis TA2-TA2 and both of thefirst and second tool articulation axes are substantially transverse tothe longitudinal tool axis LT-LT. See FIG. 207.

To facilitate selective articulation of the surgical end effector 16012about the first and second tool articulation axes TA1-TA1, TA2-TA2, thespine assembly 16102 comprises a proximal spine portion 16110 that ispivotally coupled to a distal spine portion 16120 by pivot pins 16122for selective pivotal travel about TA1-TA1. Similarly, the distal spineportion 16120 is pivotally attached to the elongated channel 16022 ofthe surgical end effector 16012 by pivot pins 16124 to enable thesurgical end effector 16012 to selectively pivot about the second toolaxis TA2-TA2 relative to the distal spine portion 16120.

In various embodiments, the articulation system 16140 further includes aplurality of articulation elements that operably interface with thesurgical end effector 16012 and an articulation control arrangement16160 that is operably supported in the tool mounting member 16200 aswill described in further detail below. In at least one embodiment, thearticulation elements comprise a first pair of first articulation cables16144 and 16146. The first articulation cables are located on a first orright side of the longitudinal tool axis. Thus, the first articulationcables are referred to herein as a right upper cable 16144 and a rightlower cable 16146. The right upper cable 16144 and the right lower cable16146 extend through corresponding passages 16147, 16148, respectivelyalong the right side of the proximal spine portion 16110. See FIG. 211.The articulation system 16140 further includes a second pair of secondarticulation cables 16150, 16152. The second articulation cables arelocated on a second or left side of the longitudinal tool axis. Thus,the second articulation cables are referred to herein as a left upperarticulation cable 16150 and a left articulation cable 16152. The leftupper articulation cable 16150 and the left lower articulation cable16152 extend through passages 16153, 16154, respectively in the proximalspine portion 16110.

As can be seen in FIG. 207, the right upper cable 16144 extends aroundan upper pivot joint 16123 and is attached to a left upper side of theelongated channel 16022 at a left pivot joint 16125. The right lowercable 16146 extends around a lower pivot joint 16126 and is attached toa left lower side of the elongated channel 16022 at left pivot joint16125. The left upper cable 16150 extends around the upper pivot joint16123 and is attached to a right upper side of the elongated channel16022 at a right pivot joint 16127. The left lower cable 16152 extendsaround the lower pivot joint 16126 and is attached to a right lower sideof the elongated channel 16022 at right pivot joint 16127. Thus, topivot the surgical end effector 16012 about the first tool articulationaxis TA1-TA1 to the left (arrow “L”), the right upper cable 16144 andthe right lower cable 16146 must be pulled in the proximal direction“PD”. To articulate the surgical end effector 16012 to the right (arrow“R”) about the first tool articulation axis TA1-TA1, the left uppercable 16150 and the left lower cable 16152 must be pulled in theproximal direction “PD”. To articulate the surgical end effector 16012about the second tool articulation axis TA2-TA2, in an upward direction(arrow “U”), the right upper cable 16144 and the left upper cable 16150must be pulled in the proximal direction “PD”. To articulate thesurgical end effector 16012 in the downward direction (arrow “DW”) aboutthe second tool articulation axis TA2-TA2, the right lower cable 16146and the left lower cable 16152 must be pulled in the proximal direction“PD”.

The proximal ends of the articulation cables 16144, 16146, 16150, 16152are coupled to the articulation control arrangement 16160 whichcomprises a ball joint assembly that is a part of the articulationtransmission 16142. More specifically and with reference to FIG. 211,the ball joint assembly 16160 includes a ball-shaped member 16162 thatis formed on a proximal portion of the proximal spine 16110. Movablysupported on the ball-shaped member 16162 is an articulation controlring 16164. As can be further seen in FIG. 211, the proximal ends of thearticulation cables 16144, 16146, 16150, 16152 are coupled to thearticulation control ring 16164 by corresponding ball joint arrangements16166. The articulation control ring 16164 is controlled by anarticulation drive assembly 16170. As can be most particularly seen inFIG. 211, the proximal ends of the first articulation cables 16144,16146 are attached to the articulation control ring 16164 atcorresponding spaced first points 16149, 16151 that are located on plane16159. Likewise, the proximal ends of the second articulation cables16150, 16152 are attached to the articulation control ring 16164 atcorresponding spaced second points 16153, 16155 that are also locatedalong plane 16159. As the present Detailed Description proceeds, thoseof ordinary skill in the art will appreciate that such cable attachmentconfiguration on the articulation control ring 16164 facilitates thedesired range of articulation motions as the articulation control ring16164 is manipulated by the articulation drive assembly 16170.

In various forms, the articulation drive assembly 16170 comprises ahorizontal articulation assembly generally designated as 16171. In atleast one form, the horizontal articulation assembly 16171 comprises ahorizontal push cable 16172 that is attached to a horizontal geararrangement 16180. The articulation drive assembly 16170 furthercomprises a vertically articulation assembly generally designated as16173. In at least one form, the vertical articulation assembly 16173comprises a vertical push cable 16174 that is attached to a verticalgear arrangement 16190. As can be seen in FIGS. 210 and 211, thehorizontal push cable 16172 extends through a support plate 16167 thatis attached to the proximal spine portion 16110. The distal end of thehorizontal push cable 16174 is attached to the articulation control ring16164 by a corresponding ball/pivot joint 16168. The vertical push cable16174 extends through the support plate 16167 and the distal end thereofis attached to the articulation control ring 16164 by a correspondingball/pivot joint 16169.

The horizontal gear arrangement 16180 includes a horizontal driven gear16182 that is pivotally mounted on a horizontal shaft 16181 that isattached to a proximal portion of the proximal spine portion 16110. Theproximal end of the horizontal push cable 16172 is pivotally attached tothe horizontal driven gear 16182 such that, as the horizontal drivengear 16172 is rotated about horizontal pivot axis HA, the horizontalpush cable 16172 applies a first pivot motion to the articulationcontrol ring 16164. Likewise, the vertical gear arrangement 16190includes a vertical driven gear 16192 that is pivotally supported on avertical shaft 16191 attached to the proximal portion of the proximalspine portion 16110 for pivotal travel about a vertical pivot axis VA.The proximal end of the vertical push cable 16174 is pivotally attachedto the vertical driven gear 16192 such that as the vertical driven gear16192 is rotated about vertical pivot axis VA, the vertical push cable16174 applies a second pivot motion to the articulation control ring16164.

The horizontal driven gear 16182 and the vertical driven gear 16192 aredriven by an articulation gear train 16300 that operably interfaces withan articulation shifter assembly 16320. In at least one form, thearticulation shifter assembly comprises an articulation drive gear 16322that is coupled to a corresponding one of the driven discs or elements11304 on the adapter side 11307 of the tool mounting plate 16202. SeeFIG. 210. Thus, application of a rotary input motion from the roboticsystem 11000 through the tool drive assembly 11010 to the correspondingdriven element 11304 will cause rotation of the articulation drive gear16322 when the interface 11230 is coupled to the tool holder 11270. Anarticulation driven gear 16324 is attached to a splined shifter shaft16330 that is rotatably supported on the tool mounting plate 16202. Thearticulation driven gear 16324 is in meshing engagement with thearticulation drive gear 16322 as shown. Thus, rotation of thearticulation drive gear 16322 will result in the rotation of the shaft16330. In various forms, a shifter driven gear assembly 16340 is movablysupported on the splined portion 16332 of the shifter shaft 16330.

In various embodiments, the shifter driven gear assembly 16340 includesa driven shifter gear 16342 that is attached to a shifter plate 16344.The shifter plate 16344 operably interfaces with a shifter solenoidassembly 16350. The shifter solenoid assembly 16350 is coupled tocorresponding pins 16352 by conductors 16352. See FIG. 210. Pins 16352are oriented to electrically communicate with slots 11258 (FIG. 104) onthe tool side 11244 of the adaptor 11240. Such arrangement serves toelectrically couple the shifter solenoid assembly 16350 to the roboticcontroller 11001. Thus, activation of the shifter solenoid 16350 willshift the shifter driven gear assembly 16340 on the splined portion16332 of the shifter shaft 16330 as represented by arrow “S” in FIGS.210 and 211. Various embodiments of the articulation gear train 16300further include a horizontal gear assembly 16360 that includes a firsthorizontal drive gear 16362 that is mounted on a shaft 16361 that isrotatably attached to the tool mounting plate 16202. The firsthorizontal drive gear 16362 is supported in meshing engagement with asecond horizontal drive gear 16364. As can be seen in FIG. 211, thehorizontal driven gear 16182 is in meshing engagement with the distalface portion 16365 of the second horizontal driven gear 16364.

Various embodiments of the articulation gear train 16300 further includea vertical gear assembly 16370 that includes a first vertical drive gear16372 that is mounted on a shaft 16371 that is rotatably supported onthe tool mounting plate 16202. The first vertical drive gear 16372 issupported in meshing engagement with a second vertical drive gear 16374that is concentrically supported with the second horizontal drive gear16364. The second vertical drive gear 16374 is rotatably supported onthe proximal spine portion 16110 for travel therearound. The secondhorizontal drive gear 16364 is rotatably supported on a portion of saidsecond vertical drive gear 16374 for independent rotatable travelthereon. As can be seen in FIG. 211, the vertical driven gear 16192 isin meshing engagement with the distal face portion 16375 of the secondvertical driven gear 16374.

In various forms, the first horizontal drive gear 16362 has a firstdiameter and the first vertical drive gear 16372 has a second diameter.As can be seen in FIGS. 210 and 211, the shaft 16361 is not on a commonaxis with shaft 16371. That is, the first horizontal driven gear 16362and the first vertical driven gear 16372 do not rotate about a commonaxis. Thus, when the shifter gear 16342 is positioned in a center“locking” position such that the shifter gear 16342 is in meshingengagement with both the first horizontal driven gear 16362 and thefirst vertical drive gear 16372, the components of the articulationsystem 16140 are locked in position. Thus, the shiftable shifter gear16342 and the arrangement of first horizontal and vertical drive gears16362, 16372 as well as the articulation shifter assembly 16320collectively may be referred to as an articulation locking system,generally designated as 16380.

In use, the robotic controller 11001 of the robotic system 11000 maycontrol the articulation system 16140 as follows. To articulate the endeffector 16012 to the left about the first tool articulation axisTA1-TA1, the robotic controller 11001 activates the shifter solenoidassembly 16350 to bring the shifter gear 16342 into meshing engagementwith the first horizontal drive gear 16362. Thereafter, the controller11001 causes a first rotary output motion to be applied to thearticulation drive gear 16322 to drive the shifter gear in a firstdirection to ultimately drive the horizontal driven gear 16182 inanother first direction. The horizontal driven gear 16182 is driven topivot the articulation ring 16164 on the ball-shaped portion 16162 tothereby pull right upper cable 16144 and the right lower cable 16146 inthe proximal direction “PD”. To articulate the end effector 16012 to theright about the first tool articulation axis TA1-TA1, the roboticcontroller 11001 activates the shifter solenoid assembly 16350 to bringthe shifter gear 16342 into meshing engagement with the first horizontaldrive gear 16362. Thereafter, the controller 11001 causes the firstrotary output motion in an opposite direction to be applied to thearticulation drive gear 16322 to drive the shifter gear 16342 in asecond direction to ultimately drive the horizontal driven gear 16182 inanother second direction. Such actions result in the articulationcontrol ring 16164 moving in such a manner as to pull the left uppercable 16150 and the left lower cable 16152 in the proximal direction“PD”. In various embodiments the gear ratios and frictional forcesgenerated between the gears of the vertical gear assembly 16370 serve toprevent rotation of the vertical driven gear 16192 as the horizontalgear assembly 16360 is actuated.

To articulate the end effector 16012 in the upper direction about thesecond tool articulation axis TA2-TA2, the robotic controller 11001activates the shifter solenoid assembly 16350 to bring the shifter gear16342 into meshing engagement with the first vertical drive gear 16372.Thereafter, the controller 11001 causes the first rotary output motionto be applied to the articulation drive gear 16322 to drive the shiftergear 16342 in a first direction to ultimately drive the vertical drivengear 16192 in another first direction. The vertical driven gear 16192 isdriven to pivot the articulation ring 16164 on the ball-shaped portion16162 of the proximal spine portion 16110 to thereby pull right uppercable 16144 and the left upper cable 16150 in the proximal direction“PD”. To articulate the end effector 16012 in the downward directionabout the second tool articulation axis TA2-TA2, the robotic controller11001 activates the shifter solenoid assembly 16350 to bring the shiftergear 16342 into meshing engagement with the first vertical drive gear16372. Thereafter, the controller 11001 causes the first rotary outputmotion to be applied in an opposite direction to the articulation drivegear 16322 to drive the shifter gear 16342 in a second direction toultimately drive the vertical driven gear 16192 in another seconddirection. Such actions thereby cause the articulation control ring16164 to pull the right lower cable 16146 and the left lower cable 16152in the proximal direction “PD”. In various embodiments, the gear ratiosand frictional forces generated between the gears of the horizontal gearassembly 16360 serve to prevent rotation of the horizontal driven gear16182 as the vertical gear assembly 16370 is actuated.

In various embodiments, a variety of sensors may communicate with therobotic controller 11001 to determine the articulated position of theend effector 16012. Such sensors may interface with, for example, thearticulation joint 16100 or be located within the tool mounting portion16200. For example, sensors may be employed to detect the position ofthe articulation control ring 16164 on the ball-shaped portion 16162 ofthe proximal spine portion 16110. Such feedback from the sensors to thecontroller 11001 permits the controller 11001 to adjust the amount ofrotation and the direction of the rotary output to the articulationdrive gear 16322. Further, as indicated above, when the shifter drivegear 16342 is centrally positioned in meshing engagement with the firsthorizontal drive gear 16362 and the first vertical drive gear 16372, theend effector 16012 is locked in the articulated position. Thus, afterthe desired amount of articulation has been attained, the controller11001 may activate the shifter solenoid assembly 16350 to bring theshifter gear 16342 into meshing engagement with the first horizontaldrive gear 16362 and the first vertical drive gear 16372. In alternativeembodiments, the shifter solenoid assembly 16350 may be spring activatedto the central locked position.

In use, it may be desirable to rotate the surgical end effector 16012about the longitudinal tool axis LT-LT. In at least one embodiment, thetransmission arrangement 16204 on the tool mounting portion includes arotational transmission assembly 16400 that is configured to receive acorresponding rotary output motion from the tool drive assembly 11010 ofthe robotic system 11000 and convert that rotary output motion to arotary control motion for rotating the elongated shaft assembly 16008(and surgical end effector 16012) about the longitudinal tool axisLT-LT. In various embodiments, for example, a proximal end portion 16041of the proximal closure tube 16040 is rotatably supported on the toolmounting plate 16202 of the tool mounting portion 16200 by a forwardsupport cradle 16205 and a closure sled 16510 that is also movablysupported on the tool mounting plate 16202. In at least one form, therotational transmission assembly 16400 includes a tube gear segment16402 that is formed on (or attached to) the proximal end 16041 of theproximal closure tube 16040 for operable engagement by a rotational gearassembly 16410 that is operably supported on the tool mounting plate16202. As can be seen in FIG. 210, the rotational gear assembly 16410,in at least one embodiment, comprises a rotation drive gear 16412 thatis coupled to a corresponding second one of the driven discs or elements11304 on the adapter side 11307 of the tool mounting plate 16202 whenthe tool mounting portion 16200 is coupled to the tool drive assembly11010. See FIG. 105. The rotational gear assembly 16410 furthercomprises a first rotary driven gear 16414 that is rotatably supportedon the tool mounting plate 16202 in meshing engagement with the rotationdrive gear 16412. The first rotary driven gear 16414 is attached to adrive shaft 16416 that is rotatably supported on the tool mounting plate16202. A second rotary driven gear 16418 is attached to the drive shaft16416 and is in meshing engagement with tube gear segment 16402 on theproximal closure tube 16040. Application of a second rotary outputmotion from the tool drive assembly 11010 of the robotic system 11000 tothe corresponding driven element 11304 will thereby cause rotation ofthe rotation drive gear 16412. Rotation of the rotation drive gear 16412ultimately results in the rotation of the elongated shaft assembly 16008(and the surgical end effector 16012) about the longitudinal tool axisLT-LT. It will be appreciated that the application of a rotary outputmotion from the tool drive assembly 11010 in one direction will resultin the rotation of the elongated shaft assembly 16008 and surgical endeffector 16012 about the longitudinal tool axis LT-LT in a firstdirection and an application of the rotary output motion in an oppositedirection will result in the rotation of the elongated shaft assembly16008 and surgical end effector 16012 in a second direction that isopposite to the first direction.

In at least one embodiment, the closure of the anvil 12024 relative tothe staple cartridge 12034 is accomplished by axially moving a closureportion of the elongated shaft assembly 12008 in the distal direction“DD” on the spine assembly 12049. As indicated above, in variousembodiments, the proximal end portion 16041 of the proximal closure tube16040 is supported by the closure sled 16510 which comprises a portionof a closure transmission, generally depicted as 16512. As can be seenin FIG. 210, the proximal end portion 16041 of the proximal closure tubeportion 16040 has a collar 6048 formed thereon. The closure sled 16510is coupled to the collar 16048 by a yoke 16514 that engages an annulargroove 16049 in the collar 16048. Such arrangement serves to enable thecollar 16048 to rotate about the longitudinal tool axis LT-LT whilestill being coupled to the closure transmission 16512. In variousembodiments, the closure sled 16510 has an upstanding portion 16516 thathas a closure rack gear 16518 formed thereon. The closure rack gear16518 is configured for driving engagement with a closure gear assembly16520. See FIG. 210.

In various forms, the closure gear assembly 16520 includes a closurespur gear 16522 that is coupled to a corresponding second one of thedriven discs or elements 11304 on the adapter side 11307 of the toolmounting plate 16202. See FIG. 210. Thus, application of a third rotaryoutput motion from the tool drive assembly 11010 of the robotic system11000 to the corresponding second driven element 11304 will causerotation of the closure spur gear 16522 when the tool mounting portion16202 is coupled to the tool drive assembly 11010. The closure gearassembly 16520 further includes a closure reduction gear set 16524 thatis supported in meshing engagement with the closure spur gear 16522 andthe closure rack gear 12106. Thus, application of a third rotary outputmotion from the tool drive assembly 11010 of the robotic system 11000 tothe corresponding second driven element 11304 will cause rotation of theclosure spur gear 16522 and the closure transmission 16512 andultimately drive the closure sled 16510 and the proximal closure tube16040 axially on the proximal spine portion 16110. The axial directionin which the proximal closure tube 16040 moves ultimately depends uponthe direction in which the third driven element 11304 is rotated. Forexample, in response to one rotary output motion received from the tooldrive assembly 11010 of the robotic system 11000, the closure sled 16510will be driven in the distal direction “DD” and ultimately drive theproximal closure tube 16040 in the distal direction “DD”. As theproximal closure tube 16040 is driven distally, the distal closure tube16042 is also driven distally by virtue of it connection with theproximal closure tube 16040. As the distal closure tube 16042 is drivendistally, the end of the closure tube 16042 will engage a portion of theanvil 16024 and cause the anvil 16024 to pivot to a closed position.Upon application of an “opening” out put motion from the tool driveassembly 11010 of the robotic system 11000, the closure sled 16510 andthe proximal closure tube 16040 will be driven in the proximal direction“PD” on the proximal spine portion 16110. As the proximal closure tube16040 is driven in the proximal direction “PD”, the distal closure tube16042 will also be driven in the proximal direction “PD”. As the distalclosure tube 16042 is driven in the proximal direction “PD”, the opening16045 therein interacts with the tab 16027 on the anvil 16024 tofacilitate the opening thereof. In various embodiments, a spring (notshown) may be employed to bias the anvil 16024 to the open position whenthe distal closure tube 16042 has been moved to its starting position.In various embodiments, the various gears of the closure gear assembly16520 are sized to generate the necessary closure forces needed tosatisfactorily close the anvil 16024 onto the tissue to be cut andstapled by the surgical end effector 16012. For example, the gears ofthe closure transmission 16520 may be sized to generate approximately70-120 pounds of closure forces.

In various embodiments, the cutting instrument is driven through thesurgical end effector 16012 by a knife bar 16530. See FIG. 210. In atleast one form, the knife bar 16530 is fabricated with a jointarrangement (not shown) and/or is fabricated from material that canaccommodate the articulation of the surgical end effector 16102 aboutthe first and second tool articulation axes while remaining sufficientlyrigid so as to push the cutting instrument through tissue clamped in thesurgical end effector 16012. The knife bar 16530 extends through ahollow passage 16532 in the proximal spine portion 16110.

In various embodiments, a proximal end 16534 of the knife bar 16530 isrotatably affixed to a knife rack gear 16540 such that the knife bar16530 is free to rotate relative to the knife rack gear 16540. Thedistal end of the knife bar 16530 is attached to the cutting instrumentin the various manners described above. As can be seen in FIG. 210, theknife rack gear 16540 is slidably supported within a rack housing 16542that is attached to the tool mounting plate 16202 such that the kniferack gear 16540 is retained in meshing engagement with a knife drivetransmission portion 16550 of the transmission arrangement 16204. Invarious embodiments, the knife drive transmission portion 16550comprises a knife gear assembly 16560. More specifically and withreference to FIG. 210, in at least one embodiment, the knife gearassembly 16560 includes a knife spur gear 16562 that is coupled to acorresponding fourth one of the driven discs or elements 11304 on theadapter side 11307 of the tool mounting plate 16202. See FIG. 105. Thus,application of another rotary output motion from the robotic system11000 through the tool drive assembly 11010 to the corresponding fourthdriven element 11304 will cause rotation of the knife spur gear 16562.The knife gear assembly 16560 further includes a knife gear reductionset 16564 that includes a first knife driven gear 16566 and a secondknife drive gear 16568. The knife gear reduction set 16564 is rotatablymounted to the tool mounting plate 16202 such that the firs knife drivengear 16566 is in meshing engagement with the knife spur gear 16562.Likewise, the second knife drive gear 16568 is in meshing engagementwith a third knife drive gear assembly 16570. As shown in FIG. 210, thesecond knife driven gear 16568 is in meshing engagement with a fourthknife driven gear 16572 of the third knife drive gear assembly 16570.The fourth knife driven gear 16572 is in meshing engagement with a fifthknife driven gear assembly 16574 that is in meshing engagement with theknife rack gear 16540. In various embodiments, the gears of the knifegear assembly 16560 are sized to generate the forces needed to drive thecutting instrument through the tissue clamped in the surgical endeffector 16012 and actuate the staples therein. For example, the gearsof the knife gear assembly 16560 may be sized to generate approximately40 to 100 pounds of driving force. It will be appreciated that theapplication of a rotary output motion from the tool drive assembly 11010in one direction will result in the axial movement of the cuttinginstrument in a distal direction and application of the rotary outputmotion in an opposite direction will result in the axial travel of thecutting instrument in a proximal direction.

As can be appreciated from the foregoing description, the surgical tool16000 represents a vast improvement over prior robotic toolarrangements. The unique and novel transmission arrangement employed bythe surgical tool 16000 enables the tool to be operably coupled to atool holder portion 11010 of a robotic system that only has four rotaryoutput bodies, yet obtain the rotary output motions therefrom to: (i)articulate the end effector about two different articulation axes thatare substantially transverse to each other as well as the longitudinaltool axis; (ii) rotate the end effector 16012 about the longitudinaltool axis; (iii) close the anvil 16024 relative to the surgical staplecartridge 16034 to varying degrees to enable the end effector 16012 tobe used to manipulate tissue and then clamp it into position for cuttingand stapling; and (iv) firing the cutting instrument to cut through thetissue clamped within the end effector 16012. The unique and novelshifter arrangements of various embodiments of the present inventiondescribed above enable two different articulation actions to be poweredfrom a single rotatable body portion of the robotic system.

The various embodiments of the present invention have been describedabove in connection with cutting-type surgical instruments. It should benoted, however, that in other embodiments, the inventive surgicalinstrument disclosed herein need not be a cutting-type surgicalinstrument, but rather could be used in any type of surgical instrumentincluding remote sensor transponders. For example, it could be anon-cutting endoscopic instrument, a grasper, a stapler, a clip applier,an access device, a drug/gene therapy delivery device, an energy deviceusing ultrasound, RF, laser, etc. In addition, the present invention maybe in laparoscopic instruments, for example. The present invention alsohas application in conventional endoscopic and open surgicalinstrumentation as well as robotic-assisted surgery.

FIG. 211 depicts use of various aspects of certain embodiments of thepresent invention in connection with a surgical tool 17000 that has anultrasonically powered end effector 17012. The end effector 17012 isoperably attached to a tool mounting portion 17100 by an elongated shaftassembly 17008. The tool mounting portion 17100 may be substantiallysimilar to the various tool mounting portions described hereinabove. Inone embodiment, the end effector 17012 includes an ultrasonicallypowered jaw portion 17014 that is powered by alternating current ordirect current in a known manner. Such ultrasonically-powered devicesare disclosed, for example, in U.S. Pat. No. 6,783,524, entitled“Robotic Surgical Tool With Ultrasound Cauterizing and CuttingInstrument”, the entire disclosure of which is herein incorporated byreference. In the illustrated embodiment, a separate power cord 17020 isshown. It will be understood, however, that the power may be suppliedthereto from the robotic controller 1001 through the tool mountingportion 17100. The surgical end effector 17012 further includes amovable jaw 17016 that may be used to clamp tissue onto the ultrasonicjaw portion 17014. The movable jaw portion 17016 may be selectivelyactuated by the robotic controller 11001 through the tool mountingportion 17100 in anyone of the various manners herein described.

FIG. 213 illustrates use of various aspects of certain embodiments ofthe present invention in connection with a surgical tool 18000 that hasan end effector 18012 that comprises a linear stapling device. The endeffector 18012 is operably attached to a tool mounting portion 18100 byan elongated shaft assembly 13700 of the type and construction describeabove. However, the end effector 18012 may be attached to the toolmounting portion 18100 by a variety of other elongated shaft assembliesdescribed herein. In one embodiment, the tool mounting portion 18100 maybe substantially similar to tool mounting portion 13750. However,various other tool mounting portions and their respective transmissionarrangements describe in detail herein may also be employed. Such linearstapling head portions are also disclosed, for example, in U.S. Pat. No.7,673,781, entitled “Surgical Stapling Device With Staple Driver ThatSupports Multiple Wire Diameter Staples”, the entire disclosure of whichis herein incorporated by reference.

Various sensor embodiments described in U.S. Patent Publication No.2011/0062212 A1 to Shelton, IV et al., the disclosure of which is hereinincorporated by reference in its entirety, may be employed with many ofthe surgical tool embodiments disclosed herein. As was indicated above,the master controller 11001 generally includes master controllers(generally represented by 11003) which are grasped by the surgeon andmanipulated in space while the surgeon views the procedure via a stereodisplay 11002. See FIG. 96. The master controllers 11001 are manualinput devices which preferably move with multiple degrees of freedom,and which often further have an actuatable handle for actuating thesurgical tools. Some of the surgical tool embodiments disclosed hereinemploy a motor or motors in their tool drive portion to supply variouscontrol motions to the tool's end effector. Such embodiments may alsoobtain additional control motion(s) from the motor arrangement employedin the robotic system components. Other embodiments disclosed hereinobtain all of the control motions from motor arrangements within therobotic system.

Such motor powered arrangements may employ various sensor arrangementsthat are disclosed in the published US patent application cited above toprovide the surgeon with a variety of forms of feedback withoutdeparting from the spirit and scope of the present invention. Forexample, those master controller arrangements 11003 that employ amanually actuatable firing trigger can employ run motor sensor(s) toprovide the surgeon with feedback relating to the amount of forceapplied to or being experienced by the cutting member. The run motorsensor(s) may be configured for communication with the firing triggerportion to detect when the firing trigger portion has been actuated tocommence the cutting/stapling operation by the end effector. The runmotor sensor may be a proportional sensor such as, for example, arheostat or variable resistor. When the firing trigger is drawn in, thesensor detects the movement, and sends an electrical signal indicativeof the voltage (or power) to be supplied to the corresponding motor.When the sensor is a variable resistor or the like, the rotation of themotor may be generally proportional to the amount of movement of thefiring trigger. That is, if the operator only draws or closes the firingtrigger in a small amount, the rotation of the motor is relatively low.When the firing trigger is fully drawn in (or in the fully closedposition), the rotation of the motor is at its maximum. In other words,the harder the surgeon pulls on the firing trigger, the more voltage isapplied to the motor causing greater rates of rotation. Otherarrangements may provide the surgeon with a feed back meter 11005 thatmay be viewed through the display 1002 and provide the surgeon with avisual indication of the amount of force being applied to the cuttinginstrument or dynamic clamping member. Other sensor arrangements may beemployed to provide the master controller 11001 with an indication as towhether a staple cartridge has been loaded into the end effector,whether the anvil has been moved to a closed position prior to firing,etc.

In alternative embodiments, a motor-controlled interface may be employedin connection with the controller 11001 that limit the maximum triggerpull based on the amount of loading (e.g., clamping force, cuttingforce, etc.) experienced by the surgical end effector. For example, theharder it is to drive the cutting instrument through the tissue clampedwithin the end effector, the harder it would be to pull/actuate theactivation trigger. In still other embodiments, the trigger on thecontroller 11001 is arranged such that the trigger pull location isproportionate to the end effector-location/condition. For example, thetrigger is only fully depressed when the end effector is fully fired.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Although the present invention has been described herein in connectionwith certain disclosed embodiments, many modifications and variations tothose embodiments may be implemented. For example, different types ofend effectors may be employed. Also, where materials are disclosed forcertain components, other materials may be used. The foregoingdescription and following claims are intended to cover all suchmodification and variations.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

1. A surgical tool for use with a robotic system that has a tool driveassembly that is operatively coupled to a control unit of the roboticsystem that is operable by inputs from an operator and is configured toprovide at least one rotary output motion to at least one rotatable bodyportion supported on the tool drive assembly, said surgical toolcomprising: a surgical end effector comprising at least one movablecomponent portion that is selectively movable between first and secondpositions relative to at least one other component portion thereof; acable drive assembly configured to apply at least one control motion tosaid at least one movable component portion of said surgical endeffector; and a tool mounting portion operably interfacing with saidcable drive assembly and the at least one rotary body portion of thetool drive assembly of the robotic system such that application of atleast one of the rotary output motions to the rotatable body portioncauses said cable drive assembly to apply at least one of said controlmotions to said at least one movable component portion.
 2. The surgicaltool of claim 1 wherein said another component portion of said surgicalend effector comprises a surgical staple cartridge and wherein one ofsaid at least one movable component portions comprises an anvil that isselectively movable between a first open position and a second closedposition relative to said surgical staple cartridge.
 3. The surgicaltool of claim 2 wherein said cable drive assembly comprises: a closurecable operably interfacing with said anvil to apply a closing motion andan opening motion thereto; and a cable drive transmission configured tooperably interface with at least one of the rotary body portions of thetool drive assembly such that an application of a first one of saidrotary output motions to the rotatable body portion in a first rotarydirection causes said closure cable to apply said closure motion to saidanvil and upon another application of said first one of said rotaryoutput motions to the rotatable body portion in a second rotarydirection causes said closure cable to apply said opening motion to saidanvil.
 4. The surgical tool of claim 3 further comprising: an elongatedshaft assembly extending between said surgical end effector and saidcable drive transmission; and a preclamping collar axially movable onsaid elongated shaft assembly and interfacing with said anvil and saidclosure cable such that said application of said first one of saidrotary output motions to the rotatable body portion in said first rotarydirection causes said preclamping collar to apply said closing motion tosaid anvil and upon said another application of said first one of saidrotary output motions to the rotatable body portion in said secondrotary direction causes said preclamping collar to apply said openingmotion to said anvil.
 5. The surgical tool of claim 3 wherein anotherone of said at least one movable component portions comprises a tissuecutting member that is axially movable within said surgical staplecartridge between a starting position and an ending position in responseto a firing motion applied thereto by said cable drive assembly.
 6. Thesurgical tool of claim 5 further comprising a firing cable operablyinterfacing with said tissue cutting member and said cable drivetransmission and wherein said cable drive transmission is selectivelyshiftable between a closure position wherein said application of saidfirst one of said rotary output motions to the rotatable body portion insaid first rotary direction causes said closure cable to apply saidclosure motion to said anvil and upon said another application of saidfirst one of said rotary output motions to the rotatable body portion insaid second rotary direction causes said closure cable to apply saidopening motion to said anvil and a firing position wherein saidapplication of said first one of said rotary output motions to therotatable body portion in a first rotary direction causes said firingcable to apply a firing motion to said tissue cutting member and uponsaid another application of said first one of said rotary output motionsto the rotatable body portion in said second rotary direction causessaid firing cable to apply a retraction motion to said tissue cuttingmember.
 7. The surgical tool of claim 6 further comprising a shiftermotor operably interfacing with said cable drive transmission for movingsaid cable drive transmission between said closure position and saidfiring position in response to corresponding control signals appliedthereto from the control unit of the robotic system.
 8. The surgicaltool of claim 6 further comprising: a firing brake engagable with saidcable drive transmission to prevent said firing cable from applying saidfiring motion to said tissue cutting member when said cable drivetransmission is in said closure position; and a closure brake engageablewith said cable drive transmission to prevent said closure cable fromapplying said opening motion to said anvil when said cable drivetransmission is in said firing position.
 9. The surgical tool of claim 1wherein another one of said at least one movable component portionscomprises a tissue cutting member that is axially movable within saidsurgical staple cartridge between a starting position and an endingposition in response to a firing motion applied thereto by said cabledrive assembly and wherein said surgical tool further comprises a knifebar operably interfacing with said cable drive assembly and the at leastone rotary body portion of the tool drive assembly of the robotic systemsuch that application of said at least one of the rotary output motionsto the rotatable body portion causes said knife bar to apply a firingcontrol motion to said cable drive assembly.
 10. A surgical tool for usewith a robotic system that has a tool drive assembly that is operativelycoupled to a control unit of the robotic system that is operable byinputs from an operator and is configured to provide at least one rotaryoutput motion to at least one rotatable body portion supported on thetool drive assembly, said surgical tool comprising: a surgical endeffector comprising: a non-movable portion; a first movable componentportion that is selectively movable between first and second positionsrelative to said non-movable portion; a second movable component portionthat is selectively movable between third and fourth positions relativeto said non-movable portion and wherein said surgical tool furthercomprises: an elongated shaft assembly operably coupled to saidnon-movable portion, said elongated shaft assembly at least partiallyoperably supporting a cable drive assembly comprising: a first cableoperably interfacing with said first movable component portion; and asecond cable operably interfacing with said second movable componentportion and wherein said surgical tool further comprises: a toolmounting portion operably coupled to said elongated shaft assembly, saidtool mounting portion being configured to operably interface with thetool drive assembly when coupled thereto, said tool mounting portioncomprising: a driven element rotatably supported on said tool mountingportion and configured for driving engagement with a corresponding oneof said at least one rotatable body portions of the tool drive assemblyto receive corresponding rotary output motions therefrom; and a cabledrive transmission assembly operably interfacing with said drivenelement and being selectively shiftable in response to control signalsfrom the control unit of the robotic system between a first actuationposition wherein an application of one of said rotary output motions tothe corresponding rotatable body portion causes said first cable to movesaid first movable component portion between said first and secondpositions and a second actuation position wherein said application ofsaid one of said rotary output motions to the corresponding rotatablebody portion causes said second cable to move said second movablecomponent portion between said third and fourth positions.
 11. Thesurgical tool of claim 10 wherein an application of said one of saidrotary output motions in a first rotary direction causes said firstmovable component portion to move from said first position to saidsecond position when said cable drive transmission assembly is in saidfirst actuation position and another application of said one of saidrotary output motions in said first rotary direction causes said secondmovable component portion to move from said third position to saidfourth position when said cable drive transmission assembly is in saidsecond actuation position.
 12. The surgical tool of claim 10 furthercomprising: a first brake engagable with said cable drive transmissionassembly to prevent said first cable from moving said first movablecomponent portion between said first and second positions when saidcable drive transmission assembly is in said second actuation position;and a second brake engagable with said cable drive transmission assemblyto prevent said second cable from moving said second movable componentportion between said third and fourth positions when said cable drivetransmission assembly is in said first actuation position.
 13. Thesurgical tool of claim 12 wherein said cable drive transmission assemblyis movable between said first and second actuation positions and aneutral position and wherein when said cable drive transmission assemblyis in said neutral position, said first brake prevents said first cablefrom moving said first movable component portion between said first andsecond positions and said second brake prevents said second cable frommoving said second movable component portion between said third andfourth positions.
 14. The surgical tool of claim 10 further comprising ashifter motor operably supported by said tool mounting portion andinterfacing with said cable drive transmission assembly and the controlunit of the robotic system.
 15. The surgical tool of claim 14 whereinsaid shifter motor is powered by at least one battery.
 16. A surgicaltool for use with a robotic system that has a tool drive assembly thatis operatively coupled to a control unit of the robotic system that isoperable by inputs from an operator and is configured to provide atleast one rotary output motion to at least one rotatable body portionsupported on the tool drive assembly, said surgical tool comprising: asurgical end effector comprising: an elongated channel configured tosupport a surgical staple cartridge; an anvil movably supported relativeto the elongated channel and being selectively movable between open andclosed positions relative to said elongated channel; and a tissuecutting member selectively axially movable between unfired and firedpositions and wherein said surgical tool further comprises: an elongatedshaft assembly operably coupled to said elongated channel; a preclampingcollar axially movable on said elongated shaft assembly for selectiveoperable engagement with said anvil; a closure cable operablyinterfacing with said preclamping collar; and a firing cable operablyinterfacing with said tissue cutting member; a tool mounting portionoperably coupled to said elongated shaft assembly, said tool mountingportion being configured to operably interface with the tool driveassembly when coupled thereto, said tool mounting portion comprising: adriven element rotatably supported on said tool mounting portion andconfigured for driving engagement with a corresponding one of said atleast one rotatable body portions of the tool drive assembly to receivecorresponding rotary output motions therefrom; and a cable drivetransmission assembly operably interfacing with said driven element andbeing selectively shiftable in response to control signals from thecontrol unit of the robotic system between a closure position wherein anapplication of one of said rotary output motions to the correspondingrotatable body portion in a first rotary direction causes said closurecable to move said preclamping collar into closing engagement with saidanvil and a firing position wherein said application of said one of saidrotary output motions in said first rotary direction to thecorresponding rotatable body portion causes said firing cable to movesaid tissue cutting member from a starting position to an endingposition within said elongated channel.
 17. The surgical tool of claim16 wherein said application of one of said rotary output motions in asecond rotary direction when said cable drive transmission assembly isin said closure position causes said closure cable to move saidpreclamping collar to move out of said closing engagement with saidanvil and when said cable drive transmission assembly is in said firingposition, said application of said one of said rotary output motions insaid second rotary directions causes said firing cable to move saidtissue cutting member from said ending position to said startingposition.
 18. The surgical tool of claim 17 further comprising: aclosure brake engagable with said cable drive transmission assembly toprevent said closure cable from moving said anvil between said open andclosed positions when said cable drive transmission assembly is in saidfiring position; and a firing brake engagable with said cable drivetransmission assembly to prevent said firing cable from moving saidtissue cutting member between said starting and ending positions whensaid cable drive transmission assembly is in said closure position. 19.The surgical tool of claim 18 wherein said cable drive transmissionassembly is movable between said closure and firing positions and aneutral position and wherein when said cable drive transmission assemblyis in said neutral position, said closure brake prevents said closurecable from moving said anvil between said open and closed positions andsaid firing brake prevents said firing cable from moving said tissuecutting member between said starting and ending positions.
 20. Thesurgical tool of claim 19 further comprising a shifter motor operablysupported by said tool mounting portion and interfacing with said cabledrive transmission assembly and the control unit of the robotic system.